Textbook oncologic outcome: A promising summary metric of high‐quality care, but are we on the same page?

Aiken, Taylor; Abbott, Daniel E.

doi:10.1002/jso.25872

Cited by 16 publications

(19 citation statements)

References 19 publications

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“…Indicators of postoperative morbidity reported in the analyzed TO studies were length of hospital stay (LOS), grade of complications, or specific complications. There is a known high correlation between LOS and incidence of complications [18].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, there is a potential bias when only reporting LOS [18,20]. LOS may not necessarily represent a surgical quality measure, as it may be prolonged by external factors such as inadequately ensured home care at discharge and not morbidity-related [18] or cultural aspects [5,17]. For these reasons, a second morbidity measure was added to the "prolonged hospital stay" parameter in the present work.…”

Section: Discussionmentioning

confidence: 99%

“…Median OS of all patients was 29 (24-35) months after resection, whereas DFS was 22 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26) months. After excluding patients who died within 90 days after resection, no significant difference between the two groups in either OS (p=0.280) or DFS (p=0.735) analysis could be detected.…”

Section: Survival Analysesmentioning

confidence: 99%

“…TO is achieved when certain predefined desirable outcomes are simultaneously present in a patient's postoperative course representing a much more comprehensive summary of a patient's hospitalization than one singular outcome parameter such as mortality [17]. There is no generally accepted definition of TO and different parameters are used to define TO depending on the type of surgery or tumor [18]. Traditional quality measures like postoperative mortality (e.g., 90-day mortality), postoperative morbidity, or length of stay (LOS) can often be found in the definition of TO, but histopathological factors such as the presence of an R0 resection are increasingly used as well [13,19,20].…”

Section: Introductionmentioning

confidence: 99%

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Textbook outcome after major hepatectomy for perihilar cholangiocarcinoma — definitions and influencing factors

Benzing

Haiden

Krenzien

et al. 2022

Langenbecks Arch Surg

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Purpose The concept of “textbook outcome” (TO) as composite quality measure depicting the ideal surgical has not yet been defined for patients undergoing major hepatectomy (MH) for perihilar cholangiocarcinoma (PHC). This study sought to propose a uniform definition through a systematic literature review as well as to identify patient- or procedure-related factors influencing TO. Methods In this retrospective study, we analyzed all patients undergoing MH for PHC at our department between January 2005 and August 2019. After conducting a systematic literature search, we defined TO as the absence of 90-day mortality and major complications, no hospital readmission within 90 days after discharge, and no prolonged hospital stay (<75. percentile). A binary logistic regression analysis was performed to identify factors influencing TO. Results Of 283 patients, TO was achieved in 67 (24%) patients. Multivariate analysis revealed that preoperative biliary drainage was associated with a decreased (OR= 0.405, 95% CI: 0.194–0.845, p=0.016) and left-sided-resection (OR= 1.899, 95% CI: 1.048–3.440, p=0.035) with increased odds for TO. Overall survival (OS) and DFS (disease-free survival) did not differ significantly between the outcome groups (OS: p=0.280, DFS: p=0.735). However, there was a trend towards better overall survival, especially in the late course with TO. Conclusion Our analysis proposed a uniform definition of TO after MH for PHC. We identified left hepatectomy as an independent factor positively influencing TO. In patients where both right- and left-sided resections are feasible, this underlines the importance of a careful selection of patients who are scheduled for right hepatectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Survival Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Textbook outcome after major hepatectomy for perihilar cholangiocarcinoma — definitions and influencing factors

Benzing

Haiden

Krenzien

et al. 2022

Langenbecks Arch Surg

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show abstract

“…Various quality indicators have been traditionally used to benchmark hospital performance regarding oncologic surgery, including, among others, postoperative mortality and morbidity, reoperation and readmission rates, lymph node yield and surgical specimen quality of resection, as well as cancer-related survival. However, these metrics may exhibit significant variability among hospitals and healthcare providers, as individual centres may score well in one indicator and poorly in another [ 12 ]. Moreover, some of these outcomes occur relatively infrequently to allow meaningful comparisons, whereas others may be poorly understood by the general public [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Achieving a Textbook Outcome in Colon Cancer Surgery Is Associated with Improved Long-Term Survival

et al. 2023

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Background: Colon cancer surgery is a complex clinical pathway and traditional quality metrics may exhibit significant variability between hospitals and healthcare providers. The Textbook Outcome (TO) is a composite quality marker capturing the fraction of patients, in whom all desired short-term outcomes of care are realised. The aim of the present study was to assess the TO in a series of non-metastatic colon cancer patients treated with curative intent, with emphasis on long-term survival. Methods: Stage I–III colon cancer patients, who underwent curative colectomy following the Complete Mesocolic Excision principles, were retrospectively identified from the institutional database. TO was defined as (i) hospital survival, (ii) radical resection, (iii) no major complications, (iv) no reintervention, (v) no unplanned stoma and (vi) no prolonged hospital stay or readmission. Results: In total, 128 patients (male 61%, female 39%, mean age 70.7 ± 11.4 years) were included in the final analysis. Overall, 60.2% achieved a TO. The highest rates were observed for “hospital survival” and “no unplanned stoma” (96.9% and 97.7%), while the lowest rates were for “no major complications” and “no prolonged hospital stay” (69.5% and 75%). Older age, left-sided resections and pT4 tumours were factors limiting the chances of a TO. The 5-year overall and 5-year cancer-specific survival were significantly better in the TO versus non-TO subgroup (81% vs. 59%, p = 0.009, and 86% vs. 65%, p = 0.02, respectively). Conclusions: Outcomes in colon cancer surgery may be affected by patient-, doctor- and hospital-related factors. TO represents those patients who achieve the optimal perioperative results, and is furthermore associated with improved long-term cancer survival.

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Novel definition of textbook outcome in biliary system cancers and its influence on patients' survival and quality of life

Atyah,

Xu,

Yang

2024

Cancer Medicine

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BackgroundThe definition of textbook outcome in biliary system cancers is a developing concept in need of expansion and investigation of its association with survival and quality of life.MethodsIn this original research, we developed a novel “all or none” textbook outcome definition which addresses the rapid recovery of post‐surgical indexes, in addition to short‐term mortality, hospital re‐admission, prolonged stay, surgical margin and postoperative complications. Based on the fulfillment of relevant criteria, patients were divided into textbook outcome and non‐textbook outcome groups and their characteristics and survival data were analyzed. A customized “quality of life” questionnaire was developed to address short‐term recovery and post‐discharge life quality of patients. Association with quality of life improvement was then investigated.ResultsA total of 129 patients were included. Textbook outcome was achieved in 25.58% of patients (37.04% of gallbladder cancer patients and 17.8% of cholangiocarcinoma patients). Compared to non‐textbook outcome group, patients with textbook outcome had lower rate of pre‐operative biliary drainage (p = 0.026), higher rate of normal preoperative liver function (p < 0.001) and tumor markers (p = 0.001), reduced perioperative bleeding (p = 0.006) and blood transfusion (p = 0.005), and higher rate of N0 stage cases (p = 0.008). Textbook outcome was also associated with enhanced survival, significantly in older patients (<65 years) (1‐year survival rate: 100% vs. 78.57% (p = 0.108), 2‐year survival rate: 87.5% vs. 44% (p = 0.046)). Finally, textbook outcome was significantly associated with enhanced basic daily performance (p < 0.001), social life performance (p = 0.033), and personal evaluation (p < 0.001), and thus improved quality of life (p < 0.001).ConclusionsThe novel definition of textbook outcome was able to address the specific nature of recovery after resection of biliary system cancers. Expanding the scope of textbook outcome and addressing the influence on survival and quality of life provides a comprehensive concept able to reflect physical, psychological and functioning enhancements in patients recovery.

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Textbook oncologic outcome: A promising summary metric of high‐quality care, but are we on the same page?

Cited by 16 publications

References 19 publications

Textbook outcome after major hepatectomy for perihilar cholangiocarcinoma — definitions and influencing factors

Textbook outcome after major hepatectomy for perihilar cholangiocarcinoma — definitions and influencing factors

Achieving a Textbook Outcome in Colon Cancer Surgery Is Associated with Improved Long-Term Survival

Novel definition of textbook outcome in biliary system cancers and its influence on patients' survival and quality of life

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