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Blogger's Note: see abstract for further stats/adjusted for ease of reading
abstract:
Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study - Burnell - 2016 - BJOG: An International Journal of Obstetrics & Gynaecology
Objective
To explore the impact of risk-adjustment on surgical complication rates (CRs) for benchmarking gynaecological oncology centres.
Design
Prospective cohort study.
Setting
Ten UK accredited gynaecological oncology centres.
Population
Women undergoing major surgery on a gynaecological oncology operating list.
Methods
Patient
co-morbidity, surgical procedures and intra-operative (IntraOp)
complications were recorded contemporaneously by surgeons for 2948 major
surgical procedures. Postoperative (PostOp) complications were
collected from hospitals and patients. Risk-prediction models for
IntraOp and PostOp complications were created using penalised (lasso)
logistic regression using over 30 potential patient/surgical risk
factors.
Main outcome measures
Observed
and risk-adjusted IntraOp and PostOp CRs for individual hospitals were
calculated. Benchmarking using colour-coded funnel plots and
observed-to-expected ratios was undertaken.
Results
Overall,
IntraOp CR was 4.7% and PostOp CR was 25.7%. The observed CRs for all hospitals were under the upper 95%
control limit for both IntraOp and PostOp funnel plots. Risk-adjustment
and use of observed-to-expected ratio resulted in one hospital moving to
the >95–98% CI (red) band for IntraOp CRs. Use of only
hospital-reported data for PostOp CRs would have resulted in one
hospital being unfairly allocated to the red band. There was little
concordance between IntraOp and PostOp CRs.
Conclusion
The
funnel plots and overall IntraOp (≈5%) and PostOp (≈26%) CRs could be
used for benchmarking gynaecological oncology centres. Hospital
benchmarking using risk-adjusted CRs allows fairer institutional
comparison. IntraOp and PostOp CRs are best assessed separately. As
hospital under-reporting is common for postoperative complications, use
of patient-reported outcomes is important.
Tweetable abstract
Risk-adjusted benchmarking of surgical complications for ten UK gynaecological oncology centres allows fairer comparison.
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