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1Department of Surgery, Monash University School of Rural Health, Bendigo, VIC, Australia
2Department of Intensive Care, Alfred Health, Melbourne, VIC, Australia
3Australian and New Zealand Intensive Care Society (ANZICS), Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia
4Australian and New Zealand Intensive Care Research Centre (ANZICS-RC), Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
© 2025 The Korean Society of Coloproctology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflict of interest
No conflict of interest relevant to this article was reported.
Funding
None.
Acknowledgments
The authors wish to acknowledge all staff involved in data collection at the participating intensive care units. A full list is provided in Supplementary Material 2.
Author contributions
Conceptualization: JAP, ZD, JB, CHAL; Data curation: ZD, DP; Formal analysis: ZD; Investigation: JAP, ZD, JB; Methodology: JAP, KRQ, CHAL, JB; Project administration: JAP, ZD, DP, CHAL, JB; Resources: JAP, ZD, CHAL; Software: ZD; Supervision: JB, DP, CHAL; Validation: ZD, KRQ; Visualization: JAP, CHAL; Writing–original draft: JAP; Writing–review & editing: all authors. All authors read and approved the final manuscript.
Characteristic | Overall (n= 23,719) | Metropolitan (n=19,611) | Rural/regional (n=4,108) | P-valuea |
---|---|---|---|---|
No. of ICUs | 164 | 122 | 42 | - |
Age (yr) | 73.5 (64.2–81.4) | 73.1 (63.8–81.3) | 74.6 (66.2–81.5) | <0.001 |
Sex | 0.500 | |||
Male | 13,088 (55.2) | 10,801 (55.1) | 2,287 (55.6) | |
Female | 10,620 (44.8) | 8,800 (44.9) | 1,820 (44.3) | |
Unknown | 11 (0.0) | 10 (0.0) | 1 (0.0) | |
Patient identified as Indigenous | 463 (2.0) | 311 (1.6) | 152 (3.7) | <0.001 |
Unknown | 2,863 (12.1) | 2,364 (12.1) | 499 (12.1) | |
Remoteness level of patient's residence | <0.001 | |||
Major city | 13,604 (57.4) | 13,328 (68.0) | 276 (6.7) | |
Inner regional | 6,433 (27.1) | 4,262 (21.7) | 2,171 (52.8) | |
Outer regional | 3,152 (13.3) | 1,628 (8.3) | 1,524 (37.1) | |
Remote/very remote | 530 (2.2) | 393 (2.0) | 137 (3.3) | |
Distance from ICU to patient's residence (km) | 13.0 (5.9–38.0) | 11.6 (5.7–29.0) | 33.3 (9.1–63.4) | <0.001 |
IRSAD score | 993 (948–1,053) | 1,010 (960–1,064) | 949 (917–973) | <0.001 |
Unknown | 21 (0.1) | 19 (0.1) | 2 (0.0) | |
Respiratory disease | 1,307 (5.5) | 1,004 (5.1) | 303 (7.4) | <0.001 |
Cardiovascular disease | 2,121 (8.9) | 1,642 (8.4) | 479 (11.7) | <0.001 |
Liver disease | 142 (0.6) | 121 (0.6) | 21 (0.5) | 0.400 |
Renal disease | 481 (2.0) | 389 (2.0) | 92 (2.2) | 0.300 |
Immunosuppressive disease | 976 (4.1) | 925 (4.7) | 51 (1.2) | <0.001 |
Immunosuppressive therapy | 1,018 (4.3) | 915 (4.7) | 103 (2.5) | <0.001 |
Hospital funding model | <0.001 | |||
Private | 12,372 (52.2) | 11,773 (60.0) | 599 (14.6) | |
Public | 11,347 (47.8) | 7,838 (40.0) | 3,509 (85.4) | |
Source of hospital admission | <0.001 | |||
Home | 21,983 (92.7) | 18,259 (93.1) | 3,724 (90.7) | |
Hospital transfer | 1,310 (5.5) | 980 (5.0) | 330 (8.0) | |
RACF/palliative care | 109 (0.5) | 75 (0.4) | 34 (0.8) | |
Unknown | 317 (1.3) | 297 (1.5) | 20 (0.5) | |
Source of ICU admission | <0.001 | |||
Operating room | 22,980 (96.9) | 19,046 (97.1) | 3,934 (95.8) | |
Ward | 314 (1.3) | 226 (1.2) | 88 (2.1) | |
Emergency department | 105 (0.4) | 51 (0.3) | 54 (1.3) | |
Hospital transfer | 320 (1.3) | 288 (1.5) | 32 (0.8) | |
ICU transfer | 0 (0) | 0 (0) | 0 (0) | |
Treatment limitation | <0.001 | |||
Full | 22,618 (95.4) | 18,851 (96.1) | 3,767 (91.7) | |
Limitation of care | 692 (2.9) | 413 (2.1) | 279 (6.8) | |
Unknown | 409 (1.7) | 347 (1.8) | 62 (1.5) | |
Type of admission to ICU | <0.001 | |||
Planned | 19,057 (80.3) | 16,280 (83.0) | 2,777 (67.6) | |
Unplanned | 4,540 (19.1) | 3,275 (16.7) | 1,265 (30.8) | |
Unknown | 122 (0.5) | 56 (0.3) | 66 (1.6) | |
Type of surgery | <0.001 | |||
Elective | 19,800 (83.5) | 16,886 (86.1) | 2,934 (71.4) | |
Emergency | 3,823 (16.1) | 2,710 (13.8) | 1,113 (27.1) | |
Unknown | 96 (0.4) | 35 (0.2) | 61 (1.5) | |
APACHE III-J score | 45 (36–55) | 45 (36–55) | 45 (36–55) | >0.999 |
Unknown | 39 (0.2) | 35 (0.2) | 4 (0.1) | |
ANZROD score | ||||
Median (IQR) | 1.07 (0.59–2.23) | 1.07 (0.59–2.20) | 1.06 (0.59–2.35) | 0.500 |
Mean±SD | 2.39±4.97 | 2.31±4.69 | 2.76±6.12 | 0.500 |
Unknown | 39 (0.2) | 35 (0.2) | 4 (0.1) | - |
Ventilated during ICU admission | 3,001 (12.7) | 2,635 (13.5) | 366 (9.0) | <0.001 |
Unknown | 58 (0.2) | 30 (0.2) | 28 (0.7) | |
Annual no. of admissions for colorectal cancer surgery per site | 32 (18–52) | 36 (19–55) | 20 (12–29) | <0.001 |
Values are presented as median (IQR), number (%), or mean±SD, unless otherwise indicated. Percentages may not total 100 due to rounding.
ICU, intensive care unit; IRSAD, Index of Relative Socio-economic Advantage and Disadvantage; RACF, residential aged care facility; APACHE, Acute Physiology and Chronic Health Evaluation; ANZROD, Australian and New Zealand Risk of Death; IQR, interquartile range; SD, standard deviation.
aWilcoxon rank sum test, Pearson chi-square test, or Fisher exact test.
Variable | OR | 95% CI | P-value |
---|---|---|---|
Hospital type | |||
Metropolitan | - | - | - |
Rural | 0.93 | 0.71–1.22 | 0.600 |
Hospital funding model | |||
Private | - | - | - |
Public | 1.61 | 1.30–2.01 | <0.001 |
Annual no. of admissions for colorectal cancer surgerya | 0.97 | 0.93–1.01 | 0.130 |
Remoteness level of patient's residence | |||
Major city | - | - | - |
Inner regional | 1.20 | 0.93–1.55 | 0.200 |
Outer regional | 1.32 | 0.92–1.88 | 0.120 |
Remote/very remote | 1.17 | 0.49–2.44 | 0.700 |
Distance from ICU to patient's residenceb (km) | 0.86 | 0.80–0.93 | <0.001 |
ANZROD model | 1.10 | 1.10–1.11 | <0.001 |
Year of admission | |||
2011 | - | - | - |
2012 | 0.80 | 0.52–1.21 | 0.300 |
2013 | 1.12 | 0.75–1.67 | 0.600 |
2014 | 0.65 | 0.41–1.01 | 0.057 |
2015 | 1.00 | 0.67–1.49 | >0.900 |
2016 | 0.81 | 0.53–1.22 | 0.300 |
2017 | 0.86 | 0.57–1.28 | 0.400 |
2018 | 0.80 | 0.54–1.19 | 0.300 |
2019 | 0.55 | 0.36–0.84 | 0.005 |
2020 | 0.73 | 0.49–1.09 | 0.120 |
2021 | 0.52 | 0.34–0.80 | 0.003 |
Outcome | Overall (n= 23,719) | Metropolitan (n=19,611) | Rural/regional (n=4,108) | P-valuea |
---|---|---|---|---|
Survival to hospital discharge | <0.001 | |||
Survived | 23,067 (97.3) | 19,104 (97.4) | 3,963.0 (96.5) | |
Died | 575 (2.4) | 442 (2.3) | 133 (3.2) | |
Unknown | 77 (0.3) | 65 (0.3) | 12 (0.3) | |
Hospital discharge destination | <0.001 | |||
Death | 575 (2.4) | 442 (2.3) | 133 (3.2) | |
Home | 19,377 (81.7) | 16,199 (82.6) | 3,178 (77.4) | |
Hospital transfer | 1,485 (6.3) | 1,015 (5.2) | 470 (11.4) | |
RACF/palliative care | 1,315 (5.6) | 1,093 (5.6) | 222 (5.4) | |
Rehabilitation | 751 (3.2) | 676 (3.4) | 75 (1.8) | |
Other | 139 (0.6) | 121 (0.6) | 18 (0.4) | |
Unknown | 77 (0.3) | 65 (0.3) | 12 (0.3) | |
ICU length of stay (day) | 1.1 (0.8–2.6) | 1.0 (0.8–2.0) | 2.1 (1.1–3.9) | <0.001 |
Unknown | 35 (0.1) | 33 (0.2) | 2 (0.0) | |
Hospital length of stay (day) | 10.0 (6.9–16.0) | 10.0 (6.9–16.2) | 9.3 (6.4–14.9) | <0.001 |
Unknown | 98 (0.4) | 76 (0.4) | 22 (0.5) | |
Readmitted to ICU | 1,463 (6.2) | 1,200 (6.1) | 263 (6.4) | 0.500 |
ICU discharge destination | 0.031 | |||
Died | 149 (0.6) | 112 (0.6) | 37 (0.9) | |
Ward | 23,098 (97.4) | 19,112 (97.5) | 3,986 (97.0) | |
Hospital transfer | 417 (1.8) | 337 (1.7) | 80 (1.9) | |
Unknown | 55 (0.2) | 50 (0.3) | 5 (0.1) |
Characteristic | Overall (n= 23,719) | Metropolitan (n=19,611) | Rural/regional (n=4,108) | P-value |
---|---|---|---|---|
No. of ICUs | 164 | 122 | 42 | - |
Age (yr) | 73.5 (64.2–81.4) | 73.1 (63.8–81.3) | 74.6 (66.2–81.5) | <0.001 |
Sex | 0.500 | |||
Male | 13,088 (55.2) | 10,801 (55.1) | 2,287 (55.6) | |
Female | 10,620 (44.8) | 8,800 (44.9) | 1,820 (44.3) | |
Unknown | 11 (0.0) | 10 (0.0) | 1 (0.0) | |
Patient identified as Indigenous | 463 (2.0) | 311 (1.6) | 152 (3.7) | <0.001 |
Unknown | 2,863 (12.1) | 2,364 (12.1) | 499 (12.1) | |
Remoteness level of patient's residence | <0.001 | |||
Major city | 13,604 (57.4) | 13,328 (68.0) | 276 (6.7) | |
Inner regional | 6,433 (27.1) | 4,262 (21.7) | 2,171 (52.8) | |
Outer regional | 3,152 (13.3) | 1,628 (8.3) | 1,524 (37.1) | |
Remote/very remote | 530 (2.2) | 393 (2.0) | 137 (3.3) | |
Distance from ICU to patient's residence (km) | 13.0 (5.9–38.0) | 11.6 (5.7–29.0) | 33.3 (9.1–63.4) | <0.001 |
IRSAD score | 993 (948–1,053) | 1,010 (960–1,064) | 949 (917–973) | <0.001 |
Unknown | 21 (0.1) | 19 (0.1) | 2 (0.0) | |
Respiratory disease | 1,307 (5.5) | 1,004 (5.1) | 303 (7.4) | <0.001 |
Cardiovascular disease | 2,121 (8.9) | 1,642 (8.4) | 479 (11.7) | <0.001 |
Liver disease | 142 (0.6) | 121 (0.6) | 21 (0.5) | 0.400 |
Renal disease | 481 (2.0) | 389 (2.0) | 92 (2.2) | 0.300 |
Immunosuppressive disease | 976 (4.1) | 925 (4.7) | 51 (1.2) | <0.001 |
Immunosuppressive therapy | 1,018 (4.3) | 915 (4.7) | 103 (2.5) | <0.001 |
Hospital funding model | <0.001 | |||
Private | 12,372 (52.2) | 11,773 (60.0) | 599 (14.6) | |
Public | 11,347 (47.8) | 7,838 (40.0) | 3,509 (85.4) | |
Source of hospital admission | <0.001 | |||
Home | 21,983 (92.7) | 18,259 (93.1) | 3,724 (90.7) | |
Hospital transfer | 1,310 (5.5) | 980 (5.0) | 330 (8.0) | |
RACF/palliative care | 109 (0.5) | 75 (0.4) | 34 (0.8) | |
Unknown | 317 (1.3) | 297 (1.5) | 20 (0.5) | |
Source of ICU admission | <0.001 | |||
Operating room | 22,980 (96.9) | 19,046 (97.1) | 3,934 (95.8) | |
Ward | 314 (1.3) | 226 (1.2) | 88 (2.1) | |
Emergency department | 105 (0.4) | 51 (0.3) | 54 (1.3) | |
Hospital transfer | 320 (1.3) | 288 (1.5) | 32 (0.8) | |
ICU transfer | 0 (0) | 0 (0) | 0 (0) | |
Treatment limitation | <0.001 | |||
Full | 22,618 (95.4) | 18,851 (96.1) | 3,767 (91.7) | |
Limitation of care | 692 (2.9) | 413 (2.1) | 279 (6.8) | |
Unknown | 409 (1.7) | 347 (1.8) | 62 (1.5) | |
Type of admission to ICU | <0.001 | |||
Planned | 19,057 (80.3) | 16,280 (83.0) | 2,777 (67.6) | |
Unplanned | 4,540 (19.1) | 3,275 (16.7) | 1,265 (30.8) | |
Unknown | 122 (0.5) | 56 (0.3) | 66 (1.6) | |
Type of surgery | <0.001 | |||
Elective | 19,800 (83.5) | 16,886 (86.1) | 2,934 (71.4) | |
Emergency | 3,823 (16.1) | 2,710 (13.8) | 1,113 (27.1) | |
Unknown | 96 (0.4) | 35 (0.2) | 61 (1.5) | |
APACHE III-J score | 45 (36–55) | 45 (36–55) | 45 (36–55) | >0.999 |
Unknown | 39 (0.2) | 35 (0.2) | 4 (0.1) | |
ANZROD score | ||||
Median (IQR) | 1.07 (0.59–2.23) | 1.07 (0.59–2.20) | 1.06 (0.59–2.35) | 0.500 |
Mean±SD | 2.39±4.97 | 2.31±4.69 | 2.76±6.12 | 0.500 |
Unknown | 39 (0.2) | 35 (0.2) | 4 (0.1) | - |
Ventilated during ICU admission | 3,001 (12.7) | 2,635 (13.5) | 366 (9.0) | <0.001 |
Unknown | 58 (0.2) | 30 (0.2) | 28 (0.7) | |
Annual no. of admissions for colorectal cancer surgery per site | 32 (18–52) | 36 (19–55) | 20 (12–29) | <0.001 |
Variable | OR | 95% CI | P-value |
---|---|---|---|
Hospital type | |||
Metropolitan | - | - | - |
Rural | 0.93 | 0.71–1.22 | 0.600 |
Hospital funding model | |||
Private | - | - | - |
Public | 1.61 | 1.30–2.01 | <0.001 |
Annual no. of admissions for colorectal cancer surgery |
0.97 | 0.93–1.01 | 0.130 |
Remoteness level of patient's residence | |||
Major city | - | - | - |
Inner regional | 1.20 | 0.93–1.55 | 0.200 |
Outer regional | 1.32 | 0.92–1.88 | 0.120 |
Remote/very remote | 1.17 | 0.49–2.44 | 0.700 |
Distance from ICU to patient's residence |
0.86 | 0.80–0.93 | <0.001 |
ANZROD model | 1.10 | 1.10–1.11 | <0.001 |
Year of admission | |||
2011 | - | - | - |
2012 | 0.80 | 0.52–1.21 | 0.300 |
2013 | 1.12 | 0.75–1.67 | 0.600 |
2014 | 0.65 | 0.41–1.01 | 0.057 |
2015 | 1.00 | 0.67–1.49 | >0.900 |
2016 | 0.81 | 0.53–1.22 | 0.300 |
2017 | 0.86 | 0.57–1.28 | 0.400 |
2018 | 0.80 | 0.54–1.19 | 0.300 |
2019 | 0.55 | 0.36–0.84 | 0.005 |
2020 | 0.73 | 0.49–1.09 | 0.120 |
2021 | 0.52 | 0.34–0.80 | 0.003 |
Outcome | Overall (n= 23,719) | Metropolitan (n=19,611) | Rural/regional (n=4,108) | P-value |
---|---|---|---|---|
Survival to hospital discharge | <0.001 | |||
Survived | 23,067 (97.3) | 19,104 (97.4) | 3,963.0 (96.5) | |
Died | 575 (2.4) | 442 (2.3) | 133 (3.2) | |
Unknown | 77 (0.3) | 65 (0.3) | 12 (0.3) | |
Hospital discharge destination | <0.001 | |||
Death | 575 (2.4) | 442 (2.3) | 133 (3.2) | |
Home | 19,377 (81.7) | 16,199 (82.6) | 3,178 (77.4) | |
Hospital transfer | 1,485 (6.3) | 1,015 (5.2) | 470 (11.4) | |
RACF/palliative care | 1,315 (5.6) | 1,093 (5.6) | 222 (5.4) | |
Rehabilitation | 751 (3.2) | 676 (3.4) | 75 (1.8) | |
Other | 139 (0.6) | 121 (0.6) | 18 (0.4) | |
Unknown | 77 (0.3) | 65 (0.3) | 12 (0.3) | |
ICU length of stay (day) | 1.1 (0.8–2.6) | 1.0 (0.8–2.0) | 2.1 (1.1–3.9) | <0.001 |
Unknown | 35 (0.1) | 33 (0.2) | 2 (0.0) | |
Hospital length of stay (day) | 10.0 (6.9–16.0) | 10.0 (6.9–16.2) | 9.3 (6.4–14.9) | <0.001 |
Unknown | 98 (0.4) | 76 (0.4) | 22 (0.5) | |
Readmitted to ICU | 1,463 (6.2) | 1,200 (6.1) | 263 (6.4) | 0.500 |
ICU discharge destination | 0.031 | |||
Died | 149 (0.6) | 112 (0.6) | 37 (0.9) | |
Ward | 23,098 (97.4) | 19,112 (97.5) | 3,986 (97.0) | |
Hospital transfer | 417 (1.8) | 337 (1.7) | 80 (1.9) | |
Unknown | 55 (0.2) | 50 (0.3) | 5 (0.1) |
Values are presented as median (IQR), number (%), or mean±SD, unless otherwise indicated. Percentages may not total 100 due to rounding. ICU, intensive care unit; IRSAD, Index of Relative Socio-economic Advantage and Disadvantage; RACF, residential aged care facility; APACHE, Acute Physiology and Chronic Health Evaluation; ANZROD, Australian and New Zealand Risk of Death; IQR, interquartile range; SD, standard deviation. Wilcoxon rank sum test, Pearson chi-square test, or Fisher exact test.
OR, odds ratio; CI, confidence interval; ICU, intensive care unit; ANZROD, Australian and New Zealand Risk of Death. For the annual number of admissions for colorectal surgery, each OR represents a +10 increase. Log-adjusted.
Values are presented as number (%) or median (interquartile range). Percentages may not total 100 due to rounding. RACF, residential aged care facility; ICU, intensive care unit. Wilcoxon rank sum test or Pearson chi-squared test.