Identification of Consensus-Based Quality End Points for Colorectal Surgery

Manwaring, Mark L.; Ko, Clifford Y.; Fleshman, James W.; Beck, David E.; Schoetz, David J.; Senagore, Anthony J.; Ricciardi, Rocco; Temple, Larissa K.; Morris, Arden M.; Delaney, Conor P.

doi:10.1097/dcr.0b013e318241b11f

Cited by 24 publications

(17 citation statements)

References 17 publications

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“…Following a modified Delphi methodology, the American Society of Colon and Rectal Surgeons generated recently a consensus of outcome measures, which identified AL as the “most important” quality indicator after colectomy. 9 If AL is to be used as a quality metric for colorectal resections, data such as these are important for valid benchmarking of providers. A better understanding of risk factors for AL may also be valuable in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

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Anastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation

Nikolian

Kamdar

Regenbogen

et al. 2017

Surgery

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121

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Background Anastomotic leak (AL) is a major source of morbidity in colorectal surgery and has become an area of interest in performance metrics. It is unclear whether AL is associated primarily with surgeons’ technical performance or explained better by patient characteristics and institutional factors. We sought to establish if AL could serve as a valid quality metric in colorectal surgery by evaluating provider variation after adjusting for patient factors. Methods We performed a retrospective cohort study of colorectal resection patients in the Michigan Surgical Quality Collaborative. Clinically relevant patient and operative factors were tested for association with AL. Hierarchical logistic regression was used to derive risk-adjusted rates of AL. Results Of 9,192 colorectal resections, 244 (2.7%) had a documented AL. The incidence of AL was 3.0% for patients with pelvic anastomoses and 2.5% for those with intra-abdominal anastomoses. Multivariable analysis showed that a greater operative duration, male sex, body mass index > 30 kg/m2, tobacco use, chronic immunosuppressive medications, thrombocytosis (platelet count > 400×109/L), and urgent/emergent surgery were independently associated with AL (C-statistic = 0.75). After accounting for patient and procedural risk factors, there were five hospitals with a significantly greater incidence of postoperative AL. Conclusions This population-based study shows that risk factors for AL include male sex, obesity, tobacco use, immunosuppression, thrombocytosis, greater operative duration, and urgent/emergent surgery; models including these factors predict most of the variation in AL rates. This study suggests that AL can serve as a valid metric that can identify opportunities for quality improvement.

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Section: Discussionmentioning

confidence: 99%

“…1–6 Prolonged duration of hospital stay, poor oncologic outcomes, and increased mortality have all been associated with AL. 7, 8 In recognition of the considerable impact of AL on patients undergoing colorectal resection, it has been identified as “the most important quality indicator” 9 after colorectal operations.…”

Section: Introductionmentioning

confidence: 99%

Anastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation

Nikolian

Kamdar

Regenbogen

et al. 2017

Surgery

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121

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“…Similarly, the American Board of Colon and Rectal Surgery (ABCRS) and the American Society of Colon and Rectal Surgeons (ASCRS) sought candidate end points for the use in developing surgeon-specific registries for case reporting and quality improvement. 26 Using a modified Delphi method, a list of structural, process, and outcomes measures were created and graded in successive rounds to evaluate their importance. However, no low-scoring metrics were removed, as there was no objective cutoff point.…”

Section: Improving Quality Measurement In Colorectal Surgerymentioning

confidence: 99%

“…A large expansion of metrics to be documented and collected may place the burden on physicians, adding to their increasing nonclinical responsibilities. 26 Furthermore, data collected in a nonsystematic fashion could lead to imperfect reporting. Finally, government and payer-directed quality improvement programs may be viewed as punitive, creating a defensive mentality among clinicians.…”

Section: Improving Quality Measurement In Colorectal Surgerymentioning

confidence: 99%

“…As mentioned earlier, members of ASCRS and ABCRS attempted to build consensus-based quality end points for colon and rectal surgery. 26 As the subspecialty covers a broad range of pathologies, the first goal was to group outcomes into disease and procedural-based categories. These categories were colectomy, rectal cancer, hemorrhoidectomy, anal fistula and abscess, colonoscopy, and rectal prolapse.…”

Section: The Best Variables To Measure Quality and Track Improvementmentioning

confidence: 99%

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Objective Assessment of Quality Measurement and Improvement

Damle

Alavi²

2014

Clinics in Colon and Rectal Surgery

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Accurate quality measurement that allows for and results in improvement is essential to colon and rectal surgery. Currently, no consensus exists as to which variables are most important in measuring outcomes. Debate continues concerning the "best" variables to measure from a structural, process, and outcomes standpoint. Although American College of Surgeons National Surgical Quality Improvement Program provides an opportunity for outcomes measurement in general and vascular surgery, there is no specific quality improvement tool available for colon and rectal surgery. However, there is growing literature testing the validity of candidate variables to be used in such a data collection system. This article evaluates the current objective assessment measurements used for quality improvement in colon and rectal surgery.

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