***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Deprivation is associated with poorer survival after surgery for colorectal cancer , but determinants of this socioeconomic ine quality are poorly understood . Methods A total of 4,296 patients undergoing surgery for colorectal cancer in 16 hospitals in the West of Scotl and between 2001 and 2004 were identified from a prospect ively maintained regional audit data base . Postoperative mortality ( < 30 days ) and 5-year relative survival by socioeconomic circumstances , measured by the area-based Scottish Index of Multiple Deprivation 2006 , were examined . Results There was no difference in age , gender , or tumor characteristics between socioeconomic groups . Compared with the most affluent group , patients from the most deprived group were more likely to present as an emergency ( 23.5 vs 19.5 % ; p = .033 ) , undergo  palliative surgery  ( 20.0 vs 14.5 % ; p < .001 ) , have higher levels of comorbidity ( p = .03 ) , have < 12 lymph nodes examined ( 56.7 vs 53.1 % ; p = .016 ) but were more likely to receive surgery under the care of a specialist surgeon ( 76.3 vs 72.0 % ; p = .001 ) . In multivariate analysis , deprivation was independently associated with increased postoperative mortality [ adjusted odds ratio 2.26 ( 95 % CI , 1.45–3.53 ; p < .001 ) ] , and poorer 5-year relative survival [ adjusted relative excess risk ( RER ) 1.25 ( 95 % CI , 1.03–1.51 ; p = .024 ) ] but not after exclusion of postoperative deaths [ adjusted RER 1.08 ( 95 % , CI .87–1.34 ; p = .472 ) ] . Conclusions The observed socioeconomic gradient in long-term survival after surgery for colorectal cancer was due to higher early postoperative mortality among more deprived groups There is strong evidence that colorectal cancer survival differs between socioeconomic groups . We analysed data on 2481 patients diagnosed during 1989–1997 and recruited to a r and omised controlled clinical trial ( AXIS , IS RCT N32414363 ) of chemotherapy and radiotherapy for colorectal cancer .  Crude and relative survival at 1 and 5 years was estimated in five categories of socioeconomic deprivation . Multiple imputation was used to account for missing data on tumour stage . A multivariable fractional polynomial model was fitted to estimate the excess hazard of death in each deprivation category , adjusting for the confounding effects of age , stage , cancer site ( colon , rectum ) and sex , using generalised linear models . Relative survival in the trial patients was higher than in the general population of Engl and and Wales .  The socioeconomic gradient in survival was much smaller than that seen for colorectal cancer patients in the general population , both at 1 year −3.2 % ( 95 % CI −7.3 to 1.0 % , P=0.14 ) and at 5 years −1.7 % ( 95 % CI −8.3 to 4.9 % , P=0.61 ) . Given equal treatment , colorectal cancer survival in Engl and and Wales does not appear to depend on socioeconomic status , suggesting that the socioeconomic gradient in survival in the general population could well be due to health-care system factors Objectives Reducing health inequalities is an explicit goal of Engl and ’s health system . Our aim was to compare the performance of  English local administrative areas  in reducing socioeconomic ine quality in emergency hospital admissions for ambulatory care sensitive chronic conditions . Methods We used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12 . We linked inpatient hospital activity , deprivation , primary care , and population data to small area neighbourhoods ( typical population 1500 ) within administrative areas ( typical population 250,000 ) . We measured absolute ine quality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age – sex-adjusted emergency admission rates . We assessed local equity performance by comparing local ine quality against national ine quality to identify areas significantly more or less equal than expected ; evaluated stability over time ; and identified where equity performance was steadily improving or worsening . We then examined associations between change in socioeconomic inequalities and change in within-area deprivation ( gentrification ) . Finally , we used administrative area-level r and om and fixed effects models to examine the contribution of primary care to inequalities in admissions . Results Data on 316 administrative areas were included in the analysis .  Local inequalities were fairly stable between consecutive years , but 32 areas ( 10 % ) showed steadily improving or worsening equity . In the 21 improving areas , the gap between most and least deprived fell by 3.9 admissions per 1000 ( six times the fall nationally ) between 2004/5 and 2011/12 , while in the 11 areas worsening , the gap widened by 2.4 . There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in ine quality . Conclusions Local equity performance in reducing ine quality in emergency admissions varies both geographically and over time . Identifying this variation could provide insights into which local delivery strategies are most effective in reducing such inequalities OBJECTIVES The aim of our study was to investigate early mortality after cardiac surgery and to determine the most adequate follow-up period for the evaluation of mortality rates . METHODS Information on all adult cardiac surgery procedures in 10 of 16 cardiothoracic centres in Netherl and s from 2007 until 2010 was extracted from the data base of Netherl and s Association for Cardio-Thoracic Surgery ( n = 33 094 ) .  Survival up to 1 year after surgery was obtained from the national death registry . Survival analysis was performed using Kaplan-Meier and Cox regression analysis . Benchmarking was performed using logistic regression with mortality rates at different time points as dependent variables , the logistic EuroSCORE as covariate and a r and om intercept per centre . RESULTS In-hospital mortality was 2.94 % ( n = 972 ) , 30-day mortality 3.02 % ( n = 998 ) , operative mortality 3.57 % ( n = 1181 ) , 60-day mortality 3.84 % ( n = 1271 ) , 6-month mortality 5.16 % ( n = 1707 ) and 1-year mortality 6.20 % ( n = 2052 ) . The survival curves showed a steep initial decline followed by stabilization after ∼60 - 120 days , depending on the intervention performed , e.g. 60 days for isolated coronary artery bypass grafting ( CABG ) and 120 days for combined CABG and valve surgery . Benchmark results were affected by the choice of the follow-up period : four hospitals changed outlier status when the follow-up was increased from 30 days to 1 year . In the isolated CABG subgroup , benchmark results were unaffected : no outliers were found using either 30-day or 1-year follow-up . CONCLUSIONS The course of early mortality after cardiac surgery differs across interventions and continues up to ∼120 days . Thirty-day mortality reflects only a part of early mortality after cardiac surgery and should only be used for benchmarking of isolated CABG procedures . The follow-up should be prolonged to capture early mortality of all types of interventions It is widely accepted that the performance of the operating surgeon affects outcomes , and this has led to the publication of surgical results in the public domain . However , the effect of other members of the multidisciplinary team is unknown . We studied the effect of the anaesthetist on mortality after cardiac surgery by analysing data collected prospect ively over ten years of consecutive cardiac surgical cases from ten UK centres .  Casemix‐adjusted outcomes were analysed in models that included r and om‐effects for centre , surgeon and anaesthetist . All cardiac surgical operations for which the EuroSCORE model is appropriate were included , and the primary outcome was in‐hospital death up to three months postoperatively . A total of 110 769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied , which included 127 consultant surgeons and 190 consultant anaesthetists . The overwhelming factor associated with outcome was patient risk , accounting for 95.75 % of the variation for in‐hospital mortality . The impact of the surgeon was moderate ( intra‐class correlation coefficient 4.00 % for mortality ) , and the impact of the anaesthetist was negligible ( 0.25 % ) . There was no significant effect of anaesthetist volume above ten cases per year . We conclude that mortality after cardiac surgery is primarily determined by the patient , with small but significant differences between surgeons . Anaesthetists did not appear to affect mortality . These findings do not support public disclosure of cardiac anaesthetists ' results , but substantially vali date current UK cardiac anaesthetic training and practice . Further research is required to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity Abstract Disparities in quality of care have always been a major challenge in health care . Providing information to patients may help to narrow such disparities . However , the relationship between level of patient information and outcomes remains to be explored . More importantly , would better-informed patients have better outcomes through their choice of higher quality providers ? We hypothesize that medical professionals may have better outcomes than nonmedical professionals following definitive surgery for colorectal cancer ( CRC ) , and their choice of provider may mediate this relationship . We identified 61,728 patients with CRC receiving definitive surgery between 2005 and 2011 from the Taiwan National Health Insurance Research Data base . Medical professionals were identified via the registry for medical personnel . Indicators for surgical outcome such as emergency room ( ER ) visits within 30 days , medical expenses , length of hospital stay ( LOS ) , and 5-year mortality were analyzed by using fixed and r and om effects multivariate regression models . Compared with nonmedical personnel CRC patients , a greater proportion of medical personnel received definitive surgery  from higher volume surgeons ( median 390 vs 311 within the study period ) and /or in higher volume hospitals ( median 1527 vs 1312 within the study period ) . CRC patients who are medical personnel had a shorter median LOS ( 12 vs 14 days ) , lower median medical expenses ( 112,687 vs 121,332 New Taiwan dollars ) , a lower ER visit rate within 30 days ( 11.3 % vs 13.0 % ) , and lower 5-year mortality . After adjusting for patient characteristics , medical personnel had a significantly lower hazard of 5-year mortality , and were significantly more likely to have a LOS shorter than 14 days than their nonmedical personnel counterparts . However , after adjusting for patient and provider characteristics , while medical personnel were significantly less likely to have a long LOS , no significant difference was observed in 5-year mortality between the 2 groups . Medical personnel did have a significantly better survival outcome and a shorter length of stay following definitive surgery than nonmedical personnel patients . The outcome disparities can be partially explained by characteristics of their treatment providers . The findings may serve as an important reference for better underst and ing how information may narrow gaps in quality of care through better choice of providers Objective : The objective of this study was to identify the determinants of 30-day postoperative mortality and long-term survival after major surgery as exemplified by 8 common operations . Summary Background Data : The National Surgical Quality Improvement Program ( NSQIP ) data base contains pre- , intra- , and 30-day postoperative data , prospect ively collected in a st and ardized fashion by a dedicated nurse review er , on major surgery in the Veterans Administration ( VA ) . The Beneficiary Identification and Records Locator Subsystem ( BIRLS ) is a VA file that depicts the vital status of U.S. veterans with 87 % to 95 % accuracy . Methods : NSQIP data were merged with BIRLS to determine the vital status of 105,951 patients who underwent 8 types of operations performed between 1991 and 1999 , providing an average follow up of 8 years . Logistic and Cox regression analyses were performed to identify the predictors of 30-day mortality and long-term survival , respectively . Results : The most important determinant of decreased postoperative survival was the occurrence , within 30 days postoperatively , of any one of 22 types of complications collected in the NSQIP . Independent of preoperative patient risk , the occurrence of a 30-day complication in the total patient group reduced median patient survival by 69 % . The adverse effect of a complication on patient survival was also influenced by the operation type and was sustained even when patients who did not survive for 30 days were excluded from the analyses . Conclusions : The occurrence of a 30-day postoperative complication is more important than preoperative patient risk and intraoperative factors in determining the survival after major surgery in the VA . Quality and process improvement in surgery should be directed toward the prevention of postoperative complications short-term prognosis of perioperative myocardial infa rct ion in patients undergoing noncardiac surgery : a cohort study . Ann Intern Med 
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Overall findings showed evidence for higher mortality in more deprived socioeconomic groups , both in the perioperative period and in the longer term .
There was no consistent approach to adjusting for co-morbidity but , where this was considered , the Charlson Co-morbidity Index was most frequently used .
This systematic review suggests that socioeconomic deprivation influences mortality after colorectal surgery