Comparing textbook outcomes among patients undergoing surgery for cancer at U. S. News & World Report ranked hospitals

Abstract

Background The objective of the current study was to define and compare rates of textbook outcomes (TO) among patients undergoing colorectal, lung, esophagus, liver, and pancreatic surgery for cancer at U.S. News & World Report (USNWR) ranked hospitals. Methods Medicare Inpatient Standard Analytic Files 2013‐2015 were utilized to examine the relationship of TO and USNWR hospital ratings following surgery for colorectal, lung, esophageal, pancreatic, and liver cancer. TO was defined as no postoperative surgical complications, no prolonged length of hospital stay, no readmission within 90 days after discharge, and no postoperative mortality within 90 days after surgery. Results Among the 35,352 Medicare patients included in the cohort, 16,820 (47.6%) underwent surgery at honor roll hospitals, whereas 18 532 (52.4%) underwent surgery at non‐honor roll hospitals. The overall proportion of patients who achieved TO was 50.1%. In examining the clinical outcomes of patients who underwent surgery, there was no difference in the odds of achieving TO at honor roll vs non‐honor roll hospitals (colorectal: odds ratio [OR], 0.87; 95% confidence interval [CI], 0.69‐1.10; lung: OR, 1.07; 95% CI, 0.87‐1.32; esophagus: OR, 1.44; 95% CI, 0.72‐2.89; liver: OR, 1.27; 95% CI, 0.87‐1.84; pancreas: OR, 1.04; 95% CI, 0.67‐1.62). Conclusion and Relevance Patients undergoing surgery for lung, esophageal, liver, pancreatic, and colorectal cancer had comparable rates of TO at honor roll vs non‐honor roll hospitals. No linear association was observed between hospital position in the rank and postoperative outcomes such as TO indicating that patients should not overly focus on the exact position within USNWR ranked hospitals. These data highlight to patients and physicians that up to one‐half of patients undergoing surgery for cancer should anticipate at least one adverse outcome.

Analysis of textbook outcomes among patients undergoing resection of retroperitoneal sarcoma: A multi‐institutional analysis of the US Sarcoma Collaborative

“…10,[12][13][14][15][16] Recent investigations have proposed a novel composite metric known as "textbook outcome" (TO) to describe when all desired perioperative outcomes have been met (ie, as described in the textbooks). 7,[15][16][17][18][19][20][21][22][23][24][25][26] Since a TO includes the most essential/integral outcome parameters of the surgical process, it provides an accurate accounting of the overall quality of care. While recent studies have introduced the concept of a TO for measuring postoperative outcomes in other complex procedures, 7,21,22,24,25 the incidence and importance of a TO have not been characterized among patients undergoing resection of RPS using a large, multi-institutional database.…”

Textbook oncologic outcome: A promising summary metric of high‐quality care, but are we on the same page?

“…There is also variability in the definition of TOO between investigators. The original definition provided by Kolfschoten et al 5 defined prolonged LOS as exceeding the 75th percentile, as does the publication by Mehta et al 2 in this issue. In contrast, Sweigert et al defines prolonged LOS as exceeding the 50th percentile, precluding half of all patients from being classified as having a TOO and contributing to the overall low rate of TOO among patients with PD in this study.…”

“…And though TOO represents a promising outcome measure in oncologic surgery, care must be taken in how this composite measure is popularized. 1,2,5,13,14 While hospital level data contributing to TOO are important for empowering patient decision making and driving quality improvement efforts, dissemination of TOO data without consensus regarding its definition or validity could easily lead to patient confusion and even variable reimbursement. Agreement regarding TOO definitions, and then studying the validity of these composite measures prospectively is necessary before broader dissemination and integration into quality measurement, hospital marketing, and negotiations with payers.…”

“…This month's issue of Journal of Surgical Oncology includes two articles exploring the concept of textbook oncologic outcome (TOO) in multiple cancer types. Sweigert et al 1 apply TOO to patients undergoing pancreaticoduodenectomy (PD), while Mehta et al 2 correlate TOO rates with U.S. News and World Report ranking for patients undergoing surgery for colorectal, lung, esophagus, liver, and pancreatic malignancies. Undoubtedly, traditional surgical quality metrics have had a significant impact on the delivery of surgical care in the United States; examples include regionalization of complex oncologic surgery due to widely recognized volume/mortality relationships and readmission being used as a marker of hospital quality 3,4 .…”

“…And though TOO represents a promising outcome measure in oncologic surgery, care must be taken in how this composite measure is popularized 1,2,5,13,14 . While hospital level data contributing to TOO are important for empowering patient decision making and driving quality improvement efforts, dissemination of TOO data without consensus regarding its definition or validity could easily lead to patient confusion and even variable reimbursement.…”