Assessing quality improvement through textbook outcomes in colorectal surgery: A systematic review.

Abstract

In recent years, an increasing interest about the evaluation and quality improvement have grown. Textbook outcome (TO) is a composite measure of several clinically important perioperative outcomes that are included in the definition of the ideal surgical care. The aim of this study is to evaluate and summarize the different definitions concerning textbook outcome in colorectal surgery. A systematic review of the literature according to PRISMA guidelines was carried out until August 2023. Primary studies on adult patients undergoing colon or rectal resection and assessing the textbook outcomes of the procedure were included. Seventeen studies were included for review. The percentage of TO achieved varied from 43–80.8%. The most prevalent variable were “no complications”, “no mortality” and “length of stay”, present in 14 studies (82.4%). The variable that contributed mostly to not meeting the definition of textbook outcome was “no complications” (41.2%) with 6 possible definitions. Other variables that were evaluated were: “readmission”, “radical resection” and “successful lymphadenectomy”. Textbook outcome is an easy-to-interpret quality assessment tool that allows monitoring and comparison of performance improvement. At the same time provide a more meaningful metric of care than individual parameters. As a result of the variability described in this systematic review, a consensus is to be reached in order to validate the extension of this tool in the area of colorectal surgery.