Risk adjusted benchmarking of abdominoperineal excision for rectal adenocarcinoma in the context of the Belgian PROCARE improvement project.

Details

Serval ID
serval:BIB_3770ABF1334E
Type
Article: article from journal or magazin.
Collection
Publications
Title
Risk adjusted benchmarking of abdominoperineal excision for rectal adenocarcinoma in the context of the Belgian PROCARE improvement project.
Journal
Gut
Author(s)
Penninckx F., Fieuws S., Beirens K., Demetter P., Ceelen W., Kartheuser A., Molle G., Van de Stadt J., Vindevoghel K., Van Eycken E., PROCARE 
Contributor(s)
PROCARE , Bertrand C., De Coninck D., Duinslaeger M., Kartheuser A., Penninckx F., Van de Stadt J., Vaneerdeweg W., Claeys D., Burnon D., Haustermans K., Scalliet P., Spaas P., Demetter P., Jouret-Mourin A., Sempoux C., Demey W., Humblet Y., Van Cutsem E., Laurent S., Van Cutsem E., Van Laethem JL. , Danse E., Op de Beeck B., Smeets P., Melange M., Rahier J., Cabooter M., Pattyn P., Peeters M., Buset M., Haeck L., Mansvelt B., Vindevoghel K., Van Eycken E., Dercq JP., Thijs A.
ISSN
1468-3288 (Electronic)
ISSN-L
0017-5749
Publication state
Published
Issued date
2013
Peer-reviewed
Oui
Volume
62
Number
7
Pages
1005-1011
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Abstract
OBJECTIVE: The abdominoperineal excision (APE) rate, a quality of care indicator in rectal cancer surgery, has been criticised if not adjusted for confounding factors. This study evaluates variability in APE rate between centres participating in PROCARE, a Belgian improvement initiative, before and after risk adjustment. It also explores the effect of merging the Hartmann resections (HR) rate with that of APE on benchmarking.
DESIGN: Data of 3197 patients who underwent elective radical resection for invasive rectal adenocarcinoma up to 15 cm were registered between January 2006 and March 2011 by 59 centres, each with at least 10 patients in the registry. Variability of APE or merged APE/HR rates between centres was analysed before and after adjustment for gender, age, ASA score (3 or more), tumour level (rectal third), depth of tumour invasion (cT4) and preoperative incontinence.
RESULTS: The overall APE rate was 21.1% (95% CI 19.7 to 22.5%). Significant variation of the APE rate was observed before and after risk adjustment (p<0.0001). For cancers in the lower rectal third, the overall APE rate increased to 45.8% (95% CI 43.1 to 48.5%). Also, variation between centres increased. Risk adjustment influenced the identification of outliers. HR was performed in only 2.6% of patients. However, merging of risk adjusted APE and HR rates identified other centres with outlying definitive colostomy rates than APE rate alone.
CONCLUSION: Significant variation of the APE rate was observed. Adjustment for confounding factors as well as merging HR with APE rates were found to be important for the assessment of performances.
Keywords
Adenocarcinoma/pathology, Adenocarcinoma/surgery, Aged, Aged, 80 and over, Belgium, Benchmarking, Confounding Factors (Epidemiology), Female, Humans, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Quality Improvement, Quality Indicators, Health Care/standards, Rectal Neoplasms/pathology, Rectal Neoplasms/surgery, Risk Adjustment/methods
Pubmed
Web of science
Create date
20/10/2016 16:42
Last modification date
03/03/2018 16:05
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