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

Celsa M Tonelli; Sujay Kulshrestha; Marc Singer; Timothy M Pawlik; Fred A Luchette; Zaid M Abdelsattar; Marshall S Baker

doi:10.1016/j.amjsurg.2022.11.038

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

Am J Surg. 2023 Mar;225(3):514-518. doi: 10.1016/j.amjsurg.2022.11.038. Epub 2022 Nov 30.

Authors

Celsa M Tonelli¹, Sujay Kulshrestha², Marc Singer², Timothy M Pawlik³, Fred A Luchette⁴, Zaid M Abdelsattar⁵, Marshall S Baker⁶

Affiliations

¹ Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA. Electronic address: https://twitter.com/celsatonelli.
² Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
³ Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁴ Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA.
⁵ Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA.
⁶ Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA. Electronic address: Mba475@gmail.com.

PMID: 36517277
DOI: 10.1016/j.amjsurg.2022.11.038

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: Oncology quality; Quality improvement; Rectal cancer; Summary sentences.

MeSH terms

Benchmarking
Humans
Neoadjuvant Therapy
Neoplasm Staging
Proctectomy*
Rectal Neoplasms* / surgery
Registries
Retrospective Studies