Highlights
- •In this first description of a CQM in Rectal Cancer, we found that CQM has the potential to be a useful metric of quality care. Achieving CQM is associated with improved overall survival. The most likely reason for failing to reach CQM is inadequate nodal assessment. As surgeons continue to strive to improve quality of care such metrics may prove to be a relevant measure of optimal care.
Abstract
Background
Quality assessment in oncologic surgery has traditionally involved reporting discrete
metrics that may be difficult for patients and referring providers to interpret. We
define a composite quality metric (CQM) for resection in rectal cancer.
Methods
We queried the National Cancer Database to identify patients undergoing low anterior
resection for clinical stage II-III rectal adenocarcinoma between 2010 and 2017. CQM
was defined as appropriate neoadjuvant therapy, margin-negative resection, appropriate
lymph node assessment, postoperative length of stay (LOS) < 75th percentile, and no
30-day readmission or mortality.
Results
19,721 patients met inclusion criteria; 8,083 (41%) had a CQM. The most common reasons
for failure to achieve CQM: inadequate node assessment (27%), prolonged LOS (26%).
On Cox modeling, CQM (aHR 0.70, 95% CI [0.66, 0.75]) was associated with improved
overall survival.
Conclusion
CQM is independently associated with improved survival in rectal cancer and may be
an effective measure of quality.
Keywords
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References
- Multidisciplinary management of rectal cancer: the OSTRICH.J Gastrointest Surg. 2013; 17: 1863-1868https://doi.org/10.1007/s11605-013-2276-4
- Focusing on desired outcomes of care after colon cancer resections; hospital variations in “textbook outcome.European J Surg Oncol Ejso. 2013; 39: 156-163https://doi.org/10.1016/j.ejso.2012.10.007
- LeapFrog. Complex adult and pediatric surgery.https://ratings.leapfroggroup.org/measure/hospital/complex-adult-and-pediatric-surgeryDate accessed: July 8, 2022
- Evaluating the validity of quality indicators for colorectal cancer care.J Surg Oncol. 2013; 108: 465-471https://doi.org/10.1002/jso.23420
- Measuring the quality of surgical care: structure, process, or outcomes?.J Am Coll Surg. 2004; 198: 626-632https://doi.org/10.1016/j.jamcollsurg.2003.11.017
- Textbook outcomes among Medicare patients undergoing hepatopancreatic surgery.Ann Surg. 2020; 271: 1116-1123https://doi.org/10.1097/sla.0000000000003105
- Textbook outcome as a composite measure in oesophagogastric cancer surgery.Br J Surg. 2017; 104: 742-750https://doi.org/10.1002/bjs.10486
- Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma.J Surg Oncol. 2020; 121: 936-944https://doi.org/10.1002/jso.25861
- Fewer than 12 lymph nodes can be expected in a surgical specimen after high-dose chemoradiation therapy for rectal cancer.Dis Colon Rectum. 2010; 53: 1023-1029https://doi.org/10.1007/dcr.0b013e3181dadeb4
- Neoadjuvant therapy for rectal cancer decreases the number of lymph nodes harvested in operative specimens.Am J Surg. 2013; 205 (discussion 292): 289-292https://doi.org/10.1016/j.amjsurg.2012.10.020
- The American society of colon and rectal surgeons clinical practice Guidelines for the management of rectal cancer.Dis Colon Rectum. 2020; 63: 1191-1222https://doi.org/10.1097/dcr.0000000000001762
- Effect of laparoscopic-assisted resection vs open resection of Stage II or III rectal cancer on pathologic outcomes. The ACOSOG Z6051 randomized clinical trial.JAMA. 2015; 314: 1346-1355
- Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial.Ann Surg. 2019; 269: 589-595https://doi.org/10.1097/SLA.0000000000003002
Article info
Publication history
Published online: November 30, 2022
Accepted:
November 29,
2022
Received in revised form:
November 23,
2022
Received:
July 8,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
☆This wrok was presented as a Podium Presentation on August 9, 2022, at the Midwestern Surgical Association Annual Conference.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
