Textbook outcome as a composite outcome measure in non-small-cell lung cancer surgery

Abstract

OBJECTIVES Quality assessment is an important element in providing surgical cancer care. The main objective of this study was to develop a new composite measure ‘textbook outcome’, to evaluate and improve quality of surgical care for patients undergoing a resection for non-small-cell lung cancer (NSCLC). METHODS All patients undergoing an anatomical resection for NSCLC from 2012 to 2016 registered in the nationwide Dutch Lung Cancer Audit were included in an analysis to assess usefulness of a composite measure as a quality indicator. Based on expert opinion, textbook outcome was defined as having a complete resection (negative resection margins and sufficient lymph node dissection), plus no 30-day or in-hospital mortality, no reintervention in 30 days, no readmission to the intensive care unit, no prolonged hospital stay (<14 days), no hospital readmission after discharge and no major complications. The percentage of patients with a textbook outcome was calculated per hospital. Between-hospital variation in textbook outcome was analysed using case-mix adjustment models. RESULTS In total, 5513 patients were included in this study. Textbook outcome was achieved in 26.4% of patients. Insufficient lymph node dissection had the most substantial effect on not realizing textbook outcome. If ‘sufficient lymph node dissection’ was not included as a criterion, textbook outcome would be 60.7%. Case-mix adjusted textbook outcome proportions per hospitals varied between 13.2% and 37.7%. CONCLUSIONS In contrast to focusing on a single aspect, the composite measure textbook outcome provides insight into comprehensive performance in NSCLC surgery. It can be used to evaluate both individual hospitals and national performance and provides the opportunity to give benchmarked feedback to thoracic surgeons.

Assessment of textbook outcome after lobectomy for early‐stage non‐small cell lung cancer in a Korean institution: A retrospective study

“…However, the individual event rate and variation of these events are low, which makes them less suitable for detecting hospital variations and measuring quality improvement. 16 TO represents ideal postoperative outcomes with various components and results in binary outcomes (achieved or failed TO). This is more understandable and informative for patients than a single metric is.…”

“…Recently, TO was defined and analyzed in lung cancer surgery using nationwide cohorts, including the Dutch Lung Cancer Audit‐Surgery (DLAS‐S) of the Netherlands and the National Cancer Database (NCBD) of the United States 15,16 . TO was achieved in about 26% of cases in both series, and insufficient lymph node (LN) assessment was the most frequent cause of failure to achieve TO (DLAS‐S, 55%; NCBD, 59.2%).…”

Evaluation of the learning curve for totally robotic single-anastomosis duodenal–ileal bypass with sleeve gastrectomy by CUSUM analysis

“…According to a review of existing "Textbook Outcome" metrics in the literature [19][20][21][22][23] , the de nition of surgical failure was subsequently expanded for totally robotic SADI-S-speci c outcomes selected based on clinician consensus among a team of bariatric surgeons at our institution. The nal de nition of surgical failure in totally robotic SADI-S included the following 5 key parameters: operative time > 210 min, length of postoperative stay > 7 days, postoperative morbid event ≥ Clavien grade II, conversion to laparotomy, and rehospitalization or death after totally robotic SADI-S. Surgical failure was recorded when any of the aforementioned parameters were observed.…”

Textbook surgical outcome in lung transplantation: Analysis of a US national registry

“…11,12 Definitions typically include indicators of perioperative quality such as early morbidity, early mortality, early readmissions, and procedure-specific variables such as margin status in oncology. [11][12][13][14][15][16] Although originally established in surgical oncology, TOs have recently been introduced in transplantation as a means to evaluate the multidimensional nature of quality of care in the increasingly complex landscape of solid organ transplantation. [17][18][19] In LTx, a TO metric composed of multiple perioperative endpoints may offer more nuanced understanding of the complex nature of LTx hospitalizations in addition to standard 1-year survival metrics and provide a means to evaluate center performance and guide quality improvement.…”