TY - JOUR
T1 - Circumferential Resection Margin as a Hospital Quality Assessment Tool for Rectal Cancer Surgery
AU - Patel, Sameer H.
AU - Hu, Chung Yuan
AU - Massarweh, Nader N.
AU - You, Y. Nancy
AU - McCabe, Ryan
AU - Dietz, David
AU - Facktor, Matthew A.
AU - Chang, George J.
N1 - Funding Information:
Support for this study: This study is supported by the Aman Trust (GJC), the Andrews Family Fund (GJC), and National Institutes of Health / National Cancer Institute grants T32 CA009599 and CA016672 (The University of Texas MD Anderson Cancer Center Support Grant).
Funding Information:
Support for this study: This study is supported by the Aman Trust (GJC), the Andrews Family Fund (GJC), and National Institutes of Health/National Cancer Institute grants T32 CA009599 and CA016672 (The University of Texas MD Anderson Cancer Center Support Grant).
Publisher Copyright:
© 2020
PY - 2020/6
Y1 - 2020/6
N2 - Background: Circumferential resection margin (CRM) status is an important predictor of outcomes after rectal cancer operation, and is influenced not only by operative technique, but also by incorporation of a multidisciplinary treatment strategy. This study sought to develop a risk-adjusted quality metric based on CRM status to assess hospital-level performance for rectal cancer operation. Study Design: We conducted a retrospective observational cohort study of 58,374 patients with resected stage I to III rectal cancer within 1,303 hospitals who were identified from the National Cancer Database (2010 to 2015). The number of observed cases with a positive CRM (≤ 1 mm) was divided by the risk-adjusted expected number of cases with positive CRM to form the observed-to-expected (O/E) ratio. Secondary endpoint was overall survival. Results: The overall rate of CRM positivity was 15.9%. Based on the O/E ratio for 1,139 hospitals, 147 (12.9%) and 103 (9.0%) were significantly worse and better performers, respectively. The majority of hospitals (n = 570) performed as expected. Positive CRMs using criteria of 0 mm and 0.1 to 1 mm were associated with a significantly shorter 5-year overall survival of 49% and 63.5% (hazard ratio 1.67; 95% CI, 1.57 to 1.76 and hazard ratio 1.19; 95% CI, 1.12 to 1.26) than negative CRM > 1 mm of 74.1% (all p < 0.001). Conclusions: CRM-based O/E ratio is a robust hospital-based quality measure for rectal cancer operation. It allows facilities to compare their performance with that of centers of similar characteristics and helps identify underperforming, at-risk, and high-performing centers. National quality-improvement initiatives for rectal cancer should focus on ensuring high-quality data collection and providing ready access to risk-adjusted comparative metrics.
AB - Background: Circumferential resection margin (CRM) status is an important predictor of outcomes after rectal cancer operation, and is influenced not only by operative technique, but also by incorporation of a multidisciplinary treatment strategy. This study sought to develop a risk-adjusted quality metric based on CRM status to assess hospital-level performance for rectal cancer operation. Study Design: We conducted a retrospective observational cohort study of 58,374 patients with resected stage I to III rectal cancer within 1,303 hospitals who were identified from the National Cancer Database (2010 to 2015). The number of observed cases with a positive CRM (≤ 1 mm) was divided by the risk-adjusted expected number of cases with positive CRM to form the observed-to-expected (O/E) ratio. Secondary endpoint was overall survival. Results: The overall rate of CRM positivity was 15.9%. Based on the O/E ratio for 1,139 hospitals, 147 (12.9%) and 103 (9.0%) were significantly worse and better performers, respectively. The majority of hospitals (n = 570) performed as expected. Positive CRMs using criteria of 0 mm and 0.1 to 1 mm were associated with a significantly shorter 5-year overall survival of 49% and 63.5% (hazard ratio 1.67; 95% CI, 1.57 to 1.76 and hazard ratio 1.19; 95% CI, 1.12 to 1.26) than negative CRM > 1 mm of 74.1% (all p < 0.001). Conclusions: CRM-based O/E ratio is a robust hospital-based quality measure for rectal cancer operation. It allows facilities to compare their performance with that of centers of similar characteristics and helps identify underperforming, at-risk, and high-performing centers. National quality-improvement initiatives for rectal cancer should focus on ensuring high-quality data collection and providing ready access to risk-adjusted comparative metrics.
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U2 - 10.1016/j.jamcollsurg.2020.02.033
DO - 10.1016/j.jamcollsurg.2020.02.033
M3 - Article
C2 - 32142927
AN - SCOPUS:85082797780
SN - 1072-7515
VL - 230
SP - 1008-1018.e5
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 6
ER -