Using textbook outcome as a measure of quality of care in oesophagogastric cancer surgery

Kaaij, Rosa T. van der; Rooij, M V de; Coevorden, Frits van; Voncken, Francine E.M.; Snæbjörnsson, Pétur; Boot, H.; Sandick, Johanna W. van

doi:10.1002/bjs.10729

Cited by 89 publications

(94 citation statements)

References 38 publications

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“…The multidimensional parameter TO is a relatively new concept which was found useful in other fields of surgery. [13][14][15]17,18 Our definition of TO was established by an international survey, conducted among experts in quality improvement in (pancreatic) surgery. Out of 17 items, absence of 6 complications was considered to reflect the ideal outcome after pancreatic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…16 Nevertheless, previous studies in other surgical fields demonstrated that TO was a feasible and useful parameter for comparison of quality between institutions, also showing correlation with improved long-term outcomes after cancer surgery. [13][14][15]17,18 This study proposes a TO definition for pancreatic surgery, based on the opinion of international experts, and assesses predictors and associations with TO in a nationwide surgical audit.…”

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confidence: 99%

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Textbook Outcome

et al. 2020

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for the Dutch Pancreatic Cancer Group Background: Textbook outcome (TO) is a multidimensional measure for quality assurance, reflecting the ''ideal'' surgical outcome. Methods: Post-hoc analysis of patients who underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP) for all indications between 2014 and 2017, queried from the nationwide prospective Dutch Pancreatic Cancer Audit. An international survey was conducted among 24 experts from 10 countries to reach consensus on the requirements for TO in pancreatic surgery. Univariable and multivariable logistic regression was performed to identify TO predictors. Between-hospital variation in TO rates was compared using observed-versus-expected rates. Results: Based on the survey (92% response rate), TO was defined by the absence of postoperative pancreatic fistula, bile leak, postpancreatectomy hemorrhage (all ISGPS grade B/C), severe complications (Clavien-Dindo !III), readmission, and in-hospital mortality. Overall, 3341 patients were included (2633 (79%) PD and 708 (21%) DP) of whom 60.3% achieved TO; 58.3% for PD and 67.4% for DP. On multivariable analysis, ASA class 3 predicted a worse TO rate after PD (ASA 3 OR 0.59 [0.44-0.80]), whereas a dilated pancreatic duct (>3 mm) and pancreatic ductal adenocarcinoma (PDAC) were associated with a better TO rate (OR 2.22 [2.05-3.57] and OR 1.36 [1.14-1.63], respectively). For DP, female sex and the absence of neoadjuvant therapy predicted better TO rates (OR 1.38 [1.01-1.90] and OR 2.53 [1.20-5.31], respectively). When comparing institutions, the observedversus-expected rate for achieving TO varied from 0.71 to 1.46 per hospital after casemix-adjustment. Conclusions: TO is a novel quality measure in pancreatic surgery. TO varies considerably between pancreatic centers, demonstrating the potential benefit of quality assurance programs.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Textbook Outcome

et al. 2020

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“…Using consensus amongst surgeons from the USSC high volume institutions based on previously published criteria, 7,20,21,23,25…”

Section: Textbook Outcomementioning

confidence: 99%

“…While there is no standardized definition that has been reached in the literature, the definition was adapted based on previously published studies and available cohort characteristics. 7,20,21,23,25 Notably, this definition does not include important patientreported outcomes such as patient satisfaction and quality of life, which have been previously demonstrated to correlate with the quality of care. [49][50][51] Future studies should employ stakeholders beyond the surgeon as well as prospective data to develop and validate consensus TO definitions.…”

Section: Long-term Impact Of Textbook Outcomementioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Wiseman

Ethun

Cloyd

et al. 2020

Journal of Surgical Oncology

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Background: The novel composite metric textbook outcome (TO) has increasingly been used as a quality indicator but has not been reported among patients undergoing surgical resection for retroperitoneal sarcoma (RPS) using multi-institutional collaborative data. Methods: All patients who underwent resection for RPS between 2000 to 2016 from eight academic institutions were included. TO was defined as a patient with R0/R1 resection that discharged to home and was without transfusion, reoperation, grade ≥2 complications, hospital-stay >50th percentile, or 90-day readmission or mortality. Univariate and multivariable analyses were performed. Results: Among 627 patients, 56.1% were female and the median age was 59 years. A minority of patients achieved a TO (34.9%). Factors associated with achieving a TO were tumor size <20 cm and low tumor grade, while ASA class ≥3, history of a prior cardiac event, resection of left colon/rectum, distal pancreatic resection, major venous resection and drain placement were associated with not achieving a TO (all P < .05). Achievement of a TO was associated with improved survival (median:12.7 vs 5.9 years, P < .01). Conclusions: Among patients undergoing resection for RPS, failure to achieve TO is common and associated with significantly worse survival. The use of TO may inform patient expectations and serve as a measure for patient-level hospital performance.

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Evaluation of Textbook Outcome as a Composite Quality Measure of Elective Laparoscopic Cholecystectomy

2022

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ImportanceA textbook outcome (TO) is a composite quality measure that incorporates multiple perioperative events to reflect the most desirable outcome. The use of TO increases the event rate, captures more outcomes to reflect patient experience, and can be used as a benchmark for quality improvement.ObjectivesTo introduce the concept of TO to elective laparoscopic cholecystectomy (LC), propose the TO criteria, and identify characteristics associated with TO failure.Design, Setting, and ParticipantsThis retrospective cohort study was performed at 3 surgical units in a single health board in the United Kingdom. Participants included all patients undergoing elective LC between January 1, 2015, and January 1, 2020. Data were analyzed from January 1, 2015, to January 1, 2020.Main Outcomes and MeasuresThe TO criteria were defined based on review of existing TO metrics in the literature for other surgical procedures. A TO was defined as an unremarkable elective LC without conversion to open cholecystectomy, subtotal cholecystectomy, intraoperative complication, postoperative complications (Clavien-Dindo classification ≥2), postoperative imaging, postoperative intervention, prolonged length of stay (>2 days), readmission within 100 days, or mortality. The rate of TOs was reported. Reasons for TO failure were reported, and preoperative characteristics were compared between TO and TO failure groups using both univariate analysis and multivariable logistic regressions.ResultsA total of 2166 patients underwent elective LC (median age, 54 [range, 13-92] years; 1579 [72.9%] female). One thousand eight hundred fifty-one patients (85.5%) achieved a TO with an unremarkable perioperative course. Reasons for TO failure (315 patients [14.5%]) included conversion to open procedure (25 [7.9%]), subtotal cholecystectomy (59 [18.7%]), intraoperative complications (40 [12.7%]), postoperative complications (Clavien-Dindo classification ≥2; 92 [29.2%]), postoperative imaging (182 [57.8%]), postoperative intervention (57 [18.1%]), prolonged length of stay (>2 days; 142 [45.1%]), readmission (130 [41.3%]), and mortality (1 [0.3%]). Variables associated with TO failure included increasing American Society of Anesthesiologists score (odds ratio [OR], 2.55 [95 CI, 1.69-3.85]; P < .001), increasing number of prior biliary-related admissions (OR, 2.68 [95% CI, 1.36-5.27]; P = .004), acute cholecystitis (OR, 1.42 [95% CI, 1.08-1.85]; P = .01), preoperative endoscopic retrograde cholangiopancreatography (OR, 2.07 [95% CI, 1.46-2.92]; P < .001), and preoperative cholecystostomy (OR, 3.22 [95% CI, 1.54-6.76]; P = .002).Conclusions and RelevanceThese findings suggest that applying the concept of TO to elective LC provides a benchmark to identify suboptimal patterns of care and enables institutions to identify strategies for quality improvement.

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Using textbook outcome as a measure of quality of care in oesophagogastric cancer surgery

Abstract: Textbook outcome is a clinically relevant measure in patients undergoing oesophagogastric cancer surgery as it can identify underperforming parameters in a hospital setting. Overall survival in patients with a textbook outcome is better than in patients without a textbook outcome.

Cited by 89 publications

References 38 publications

Textbook Outcome

Textbook Outcome

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

Evaluation of Textbook Outcome as a Composite Quality Measure of Elective Laparoscopic Cholecystectomy

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