Benchmarking survival outcomes: A funnel plot for survival data

Putter, Hein; Eikema, Dirk‐Jan; Wreede, Liesbeth C. de; McGrath, Eoin; Sánchez-Ortega, Isabel; Saccardi, Riccardo; Snowden, John A.; Zwet, Erik W. van

doi:10.1177/09622802221084130

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…12 Readmission and survival plots were analyzed in R using package success ( https://CRAN.R-project.org/package=success ). 13 …”

Section: Methodsmentioning

confidence: 99%

Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis

Evans,

Kamarajah,

Evison

et al. 2024

Annals of Surgery Open

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Objective: The aim of this study is to identify risk factors for readmission after elective esophagogastric cancer surgery and characterize the impact of readmission on long-term survival. The study will also identify whether the location of readmission to either the hospital that performed the primary surgery (index hospital) or another institution (nonindex hospital) has an impact on postoperative mortality. Background: Over the past decade, the center-volume relationship has driven the centralization of major cancer surgery, which has led to improvements in perioperative mortality. However, the impact of readmission, especially to nonindex centers, on long-term mortality remains unclear. Methods: This was a national population-based cohort study using Hospital Episode Statistics of adult patients undergoing esophagectomy and gastrectomy in England between January 2008 and December 2019. Results: This study included 27,592 patients, of which overall readmission rates were 25.1% (index 15.3% and nonindex 9.8%). The primary cause of readmission to an index hospital was surgical in 45.2% and 23.7% in nonindex readmissions. Patients with no readmissions had significantly longer survival than those with readmissions (median: 4.5 vs 3.8 years; P < 0.001). Patients readmitted to their index hospital had significantly improved survival as compared to nonindex readmissions (median: 3.3 vs 4.7 years; P < 0.001). Minimally invasive surgery and surgery performed in high-volume centers had improved 90-day mortality (odds ratio, 0.75; P < 0.001; odds ratio, 0.60; P < 0.001). Conclusion: Patients requiring readmission to the hospital after surgery have an increased risk of mortality, which is worsened by readmission to a nonindex institution. Patients requiring readmission to the hospital should be assessed and admitted, if required, to their index institution.

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“…12 Readmission and survival plots were analyzed in R using package success ( https://CRAN.R-project.org/package=success ). 13 …”

Section: Methodsmentioning

confidence: 99%

Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis

Evans,

Kamarajah,

Evison

et al. 2024

Annals of Surgery Open

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“…If the patients with longer follow-up are not representative of the entire transplant population this results in bias in outcomes analyses. EBMT is committed to remedy this problem in the context of a benchmarking process [19,20].…”

Section: Censoringmentioning

confidence: 99%

Analysis of survival outcomes in haematopoietic cell transplant studies: Pitfalls and solutions

Wreede

Schetelig

Putter³

2022

Bone Marrow Transplant

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SERIES EDITOR INTRODUCTIONThe final article in our Statistics Series by de Wreede and colleagues deals with the important issue of survival analyses in general and in recipients of haematopoietic cell transplants specifically. At first glance analyzing survival should be simple. The endpoint is clear with rare exception, the subject is either alive or dead. Compare this to other less well defined transplant-related outcomes such as who has acute graft-versus-host disease (GvHD) and of what grade or what is the cause of interstitial pneumonia. There is also the complexity of composite endpoints when one analyzes outcomes such as event-free (EFS) or relapse-free survival (RFS).Here you're either alive or dead. Period. Alas, as it turns out things are not so simple. As the authours point out: it takes time to observe time. It is almost never possible to wait long enough for everyone in a study to die. (Some people who are cured by a transplant will outlive their physician and statistician.) Other subjects may not be followed until the end of the study, lost to followup or withdraw consent to participate. Often these are non-random events, muddy the water and make what seems a simple analysis of survival not so. Fortunately, de Wreede and colleagues discuss the issues of informative and non-informative censoring and time-dependent co-variates. And there are other nasty complexities such non-proportional hazards of death say when initially there is a survival disadvantage to transplants from transplant-related mortality followed in 1-2 years by a survival benefit. They emphasize the danger of considering only Hazard Ratio in this setting. Lastly, the authours discuss how to compare interventions such as conventional therapy versus a haematopoietic cell transplant when the endpoint of interest is survival. We think this article will be of considerable interest to readers of BONE MARROW TRANSPLANTATION and suggest you study it carefully. Survival analyses, seemingly simple, are a potential minefield. You don't want to step on one. This article and the entire Statistics Series are available online at https://www.nature.com/collections/ejhigdbeeh.

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Survival of patients with colorectal liver metastases treated with and without preoperative chemotherapy: Nationwide propensity score-matched study

Graaff

Klaase

Dam

et al. 2023

European Journal of Surgical Oncology

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Benchmarking survival outcomes: A funnel plot for survival data

Cited by 5 publications

References 19 publications

Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis

Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis

Analysis of survival outcomes in haematopoietic cell transplant studies: Pitfalls and solutions

Survival of patients with colorectal liver metastases treated with and without preoperative chemotherapy: Nationwide propensity score-matched study

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