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Use of a national registry to define a composite quality metric for rectal cancer

Published:November 30, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.11.038

      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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