Quality-of-care indicators for oesophageal cancer surgery: A review

Abstract

Background

Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery

“…Thus, quality data for structural or procedural factors (e.g., waiting times, possibilities of comprehensive staging and preoperative risk stratification, the presence of interdisciplinary tumor conferences, expertise of the healthcare team, the number of intensive care unit staff, morbidity and mortality conferences) as well as further therapy outcome measures [e.g., toxicity criteria of multimodal treatment concepts, patient safety, hospital readmission rates, longterm survival, patient satisfaction and quality of life, in particular health-related quality of life (HRQOL) and quality-adjusted life years (QALYs)] are of equal relevance, although with lower levels of evidence in the literature [24]. Evidence-based benchmarking for the above parameters or a national expanded quality assurance program for a comprehensive evaluation of quality dimensions of hospitals treating patients with esophageal carcinoma, analogous, for example, to the nationwide registration of outcome data for the improvement in quality of care for rectal surgery-an initiative of the European Society for Surgical Oncology (ESSO)-is currently not in existence [65].…”

“…Similarly, the US Agency for Healthcare Research and Quality (AHRQ) has focused on case volume as a quality indicator for different high-risk surgical procedures, such as esophagectomies [23]. The demonstrated strong evidence of lower postoperative mortality after oncologic esophagectomy in high-volume hospitals was further confirmed for the surgeon volume [8,24]. On a critical note, it needs to be mentioned that the majority of the published analysis has employed conventional techniques instead of using multi-level modeling, which do not take into consideration groupings of events (levels of patient and hospital variables, e.g., hospital volumes) and may thus have overestimated the volume-outcome relationship [25].…”

“…Critics of the quality indicator ''hospital volume'' place particularly such patient-related predictors of mortality after esophagectomy as, for example, age and comorbidity in the foreground [26]. However, Courrech Staal et al [24] found evidence of an association between hospital and surgeon volume and postoperative mortality in a study based solely on univariate and multivariate analyses (8 analyzed articles). An evaluation of popular media and internet-based hospital quality ratings for oncologic visceral surgical interventions demonstrated that although publically marketed rating systems are capable of identifying highly qualified hospitals, these evaluations are not able to distinguish other high-volume hospitals of similar quality [27].…”

Quality indicators for oesophageal and gastric cancer: a population-based study in Belgium, 2004-2008

“…; Courrech Staal et al . ), which were evaluated based on their full text. Globally, 28 QIs were retrieved from these published sources.…”

Oncologic Quality Indicators in Thoracic Surgery

“…A recent review by Courrech Staal et al 32 explored the published evidence behind a very wide range of quality metrics that have been suggested in esophageal cancer operations using the Donabedian framework of structure, process, and outcome measures. With regards to structural measures that affected postoperative mortality, the authors found there was strong or considerable evidence for high volume hospitals and surgeons, as well as surgeons with thoracic specialty training.…”