Benchmarks in colorectal surgery: multinational study to define quality thresholds in high and low anterior resection

• Published in: British journal of surgery Vol. 109; no. 12; pp. 1274 - 1281
• Main Authors: Staiger, Roxane D, Rössler, Fabian, Kim, Min Jung, Brown, Carl, Trenti, Loris, Sasaki, Takeshi, Uluk, Deniz, Campana, Juan P, Giacca, Massimo, Schiltz, Boris, Bahadoer, Renu R, Lee, Kai-Yin, Kupper, Bruna E C, Hu, Katherine Y, Corcione, Francesco, Paredes, Steven R, Spampati, Sebastiano, Ukegjini, Kristjan, Jedrzejczak, Bartlomiej, Langer, Daniel, Stakelum, Aine, Park, Ji Won, Phang, P Terry, Biondo, Sebastiano, Ito, Masaaki, Aigner, Felix, Vaccaro, Carlos A, Panis, Yves, Kartheuser, Alex, Peeters, K C M J, Tan, Ker-Kan, Aguiar, Samuel, Ludwig, Kirk, Bracale, Umberto, Young, Christopher J, Dziki, Adam, Ryska, Miroslav, Winter, Des C, Jenkins, John T, Kennedy, Robin H, Clavien, Pierre-Alain, Puhan, Milo A, Turina, Matthias
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 22-11-2022
• Subjects: Benchmarking; Colorectal Surgery; Humans; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctectomy; Rectal Neoplasms - surgery; Retrospective Studies
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1093/bjs/znac300

Abstract
Background
Benchmark comparisons in surgery allow identification of gaps in the quality of care provided. The aim of this study was to determine quality thresholds for high (HAR) and low (LAR) anterior resections in colorectal cancer surgery by applying the concept of benchmarking.
Methods
This 5-year multinational retrospective study included patients who underwent anterior resection for cancer in 19 high-volume centres on five continents. Benchmarks were defined for 11 relevant postoperative variables at discharge, 3 months, and 6 months (for LAR). Benchmarks were calculated for two separate cohorts: patients without (ideal) and those with (non-ideal) outcome-relevant co-morbidities. Benchmark cut-offs were defined as the 75th percentile of each centre’s median value.
Results
A total of 3903 patients who underwent HAR and 3726 who had LAR for cancer were analysed. After 3 months’ follow-up, the mortality benchmark in HAR for ideal and non-ideal patients was 0.0 versus 3.0 per cent, and in LAR it was 0.0 versus 2.2 per cent. Benchmark results for anastomotic leakage were 5.0 versus 6.9 per cent for HAR, and 13.6 versus 11.8 per cent for LAR. The overall morbidity benchmark in HAR was a Comprehensive Complication Index (CCI®) score of 8.6 versus 14.7, and that for LAR was CCI® score 11.9 versus 18.3.
Conclusion
Regular comparison of individual-surgeon or -unit outcome data against benchmark thresholds may identify gaps in care quality that can improve patient outcome.
This article describes the first multinational endeavour to determine quality thresholds in colorectal cancer surgery. Such benchmarks were defined for patients with and without outcome-relevant co-morbidities. These benchmarks may help detect quality gaps regarding postoperative outcome.