Value of individual surgeon performance metrics as quality assurance measures in oesophagogastric cancer surgery

Abstract

Background: Surgeon-level operative mortality is widely seen as a measure of quality after gastric and oesophageal resection. This study aimed to evaluate this alongside a compound-level outcome analysis.Methods: Consecutive patients who underwent treatment including surgery delivered by a multidisciplinary team, which included seven specialist surgeons, were studied. The primary outcome was death within 30 days of surgery; secondary outcomes were anastomotic leak, Clavien-Dindo morbidity score, lymph node harvest, circumferential resection margin (CRM) status, disease-free (DFS), and overall (OS) survival.Results: The median number of annual resections per surgeon was 10 (range 5-25), compared with 14 (5-25) for joint consultant teams (P = 0⋅855). The median annual surgeon-level mortality rate was 0 (0-9) per cent versus an overall network annual operative mortality rate of 1⋅8 (0-3⋅7) per cent. Joint consultant team procedures were associated with fewer operative deaths (0⋅5 per cent versus 3⋅4 per cent at surgeon level; P = 0⋅027). The median surgeon anastomotic leak rate was 12⋅4 (range 9-20) per cent (P = 0⋅625 versus the whole surgical range), overall morbidity 46⋅5 (31-60) per cent (P = 0⋅066), lymph node harvest 16 (9-29) (P < 0⋅001), CRM positivity 32⋅0 (16-46) per cent (P = 0⋅003), 5-year DFS rate 44⋅8 (29-60) per cent and OS rate 46⋅5 (35-53) per cent. No designated metrics were independently associated with DFS or OS in multivariable analysis. Conclusion:Annual surgeon-level metrics demonstrated wide variations (fivefold), but these performance metrics were not associated with survival.

Neutrophil to lymphocyte ratio as a predictor of response to neoadjuvant chemotherapy and survival in oesophageal adenocarcinoma

“…A National Health Service laboratory using standardized techniques performed the serum analyses and histopathological examinations, so reproducing these results should be easy. Patients were recruited from a consecutive series diagnosed with OAC, from a single UK geographical region, all treated by the same group of specialists, using a standardized staging algorithm and operative techniques, with internationally recognized and published key performance indicators.…”

“…To test the proposed hypotheses, a single cohort of patients diagnosed with OAC between 1 January 2010 and 31 August 2018 was recruited, and included patients with radiological TNM stage I–III deemed amenable to treatment with curative intent. All patients were managed by a multidisciplinary specialist team (MDT) with an interest in oesophageal cancer, including clinical nurse specialists, gastroenterologists, surgeons, oncologists, radiologists, anaesthetists and pathologists. Management plans were individually tailored according to both patient and disease factors.…”

Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery

“…The study, however, has several strengths. Patients were recruited from a consecutive series of patients diagnosed with oesophageal cancer, from a single UK geographical region, all treated by the same specialist team, using a standardized staging algorithm and team‐based operative techniques, with international audited and published quality control 35 .…”

Prognostic significance of compound physiology variables in oesophageal cancer

“…Moreover, the patients were recruited from a consecutive series of patients diagnosed with OC, from a single UK geographical region, all treated by the same specialist MDT, using a standardized staging algorithm and team-based operative techniques, with international audited and published quality control. 19…”

“…All patients were managed by a multidisciplinary specialist team (MDT), with an interest in OC, and included clinical nurse specialists, gastroenterologists, surgeons, oncologists, radiologists, anaesthetists and pathologists. 19 Management plans were individually tailored according to factors relating to both the patient and their disease. Patients were staged using computed tomography, endoscopic ultrasound, computed tomography positron emission tomography, and staging laparoscopy as appropriate.…”