Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study

Burnell, Matthew; Iyer, R. Rajagopalan; Gentry-Maharaj, A.; Nordin, Andy; Liston, Robert; Manchanda, Ranjit; Das, Nagindra; Gornall, Robert; Beardmore-Gray, Alice; Hillaby, K.; Leeson, Simon; Linder, Anders; Lopes, Alberto; Meechan, David; Mould, Tim; Nevin, James; Olaitan, Adeola; Rufford, Barnaby; Shanbhag, Smruta; Thackeray, Anne; Wood, N; Reynolds, Karina; Ryan, Andy; Menon, Usha

doi:10.1111/1471-0528.13994

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…In this study a retrospective analysis of women who underwent surgery for gynaecological malignancies was carried out to assess how useful the NSQIP calculator is in predicting the risk of complications in the postoperative period and how well the calculator identifies patients who are at above average risk of complications. Overall, post-operative complication rates in this centre were comparable to those of gynaeoncology surgery across the UK [17].…”

Section: Discussionmentioning

confidence: 64%

The Utility of a Personalised Risk Calculator in Gynae-Oncology Surgery

Murray¹,

Lim²,

Howells³

et al. 2020

COR

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Objective: The objective of this study was to assess the ability of the American College of Surgeons (ACS) NSQIP surgical risk calculator to accurately identify patients at increased risk of perioperative complication following surgery for gynaecological malignancy. Methods: A retrospective review of 142 patients who underwent major surgery under the gynae-oncology team between 06/08/2018-16/04/2019 at the University Hospital of Wales. Pre-operative factors combined with a procedure-specific code generated the predicted risk of 13 post-operative complications for each patient. Brier scores assessed calibration and receiver operated curves (AUC) evaluated the discriminative power of NSQIP. Results: Complications were experienced by 50/142 (35.2%) patients. The calculator displayed adequate calibration when used to predict serious complications (Brier = 0.070), readmission (Brier = 0.058), return to OR (Brier = 0.000) and UTI (Brier = 0.001). It had the greatest discriminative power when predicting the risk of serious complications (AUC = 0.672; 95% CI, 0.481-0.863). The calculator successfully identified a majority of patients who had a complication as being of ‘above average risk’ for all complications, apart from return to OR, based on their pre-operative factors. Discussion: NSQIP has previously been demonstrated to be a useful pre-operative tool for evaluating the risk of post-operative complications in colorectal surgery. This study suggests that in the setting of gynaeoncology surgery the calculator does not have adequate discriminative power to be an absolute predictor of all complications, however, it may be useful in identifying patients who are likely to develop serious complications and those at above average risk of complications.

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Section: Discussionmentioning

confidence: 64%

The Utility of a Personalised Risk Calculator in Gynae-Oncology Surgery

Murray¹,

Lim²,

Howells³

et al. 2020

COR

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“…Country income groups were determined as per the World Bank classification system. Whilst there is a paucity of data on morbidity and mortality following gynaecological oncology surgery in LMICs, data for HICs suggests 26% morbidity [6] and 2% mortality [7]. For a baseline 26% morbidity incidence in HICs, 450 patients per arm (HIC versus LMIC) allows a 10% point difference to be detected at 90% power, α = 0.05.…”

Section: Sample Sizementioning

confidence: 99%

International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1)

Gaba,

Ash,

Blyuss

et al. 2023

Cancers

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Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien–Dindo I–II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien–Dindo III–V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054–2.061, p = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066–1.472, p = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081–1.502, p = 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128–1.664, p = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175–1.664, p ≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509–5.894, p = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention.

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“…In the medical literature there are many diverse approaches that refer to benchmarking, but, interestingly, very few actually use the best as the threshold. Instead, comparison with the average is the most common process, which does not correspond to benchmarking as it has been developed and implemented in the business world ( Appendix S1 , supporting information).…”

Section: Introductionmentioning

confidence: 99%

Improving surgical outcomes through benchmarking

Staiger

Schwandt

Puhan

et al. 2019

Journal of British Surgery

100

130

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Benchmarking is a popular quality‐improvement tool in economic practice. Its basic principle consists of identifying the best (the benchmark), then comparing with the best, and learning from the best. In healthcare, the concept of benchmarking or establishing benchmarks has been less specific, where comparisons often do not target the best, but the average results. The goal, however, remains improvement in patient outcome. This article outlines the application of benchmarking and proposes a standard approach of benchmark determination in surgery, including the establishment of best achievable real‐world postoperative outcomes. Parameters used for this purpose must be reproducible, objective and universal. A systematic approach for determining benchmarks enables self‐assessment of surgical outcome and facilitates the detection of areas for improvement. The intention of benchmarking is to stimulate surgeons' genuine endeavour for perfection, rather than to judge centre or surgeon performance.

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Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study

Abstract: Risk-adjusted benchmarking of surgical complications for ten UK gynaecological oncology centres allows fairer comparison.

Cited by 6 publications

References 21 publications

The Utility of a Personalised Risk Calculator in Gynae-Oncology Surgery

The Utility of a Personalised Risk Calculator in Gynae-Oncology Surgery

International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1)

Improving surgical outcomes through benchmarking

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