University Hospital Coventry, Clifford Bridge Rd, Coventry, CV2 2DX, UK.
University Hospital Coventry, Clifford Bridge Rd, Coventry, CV2 2DX, UK.
Int J Surg. 2018 Sep;57:101-104. doi: 10.1016/j.ijsu.2018.08.005. Epub 2018 Aug 21.
Since 2013, individual surgeon and NHS Trusts outcomes following elective colorectal cancer surgery have been in the public domain in England. The 90-day operative mortality rates following colorectal resections are available for the public to view online.
The aim of this study is to evaluate the quality of the published data. It also aims to find whether this data will show the expected pattern of inverse correlation between case volume and the postoperative 90-day mortality rate.
The postoperative 90-day mortality data was taken from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) website. Surgeons and Trusts were categorized according to case volume. Completeness of data at Trust and surgeon levels was analysed. All statistical analyses were performed in Statistical Package for Social Science (SPSS, version 23, IBM, Armonk, NY).
788 colorectal surgeons performed 73,842 resections for colorectal cancer in 143 hospitals over a 5-year period (1st April 2010 and 31st March 2015). The mean national 90-day mortality after colorectal resections was 2.6%. No significant effect was identified when mortality rates were correlated with the surgeon or Trust volume. There was a missing data of 3874 patients in the individual surgeon level analysis when compared to the number of procedures included in Trust analysis (73,842 vs 69,968 cases). About one-third of hospitals (n = 43) had a case ascertainment of less than 90%. Out of the 788 surgeons, there were only two outliers whose mortality rates were outside the "funnel limit".
The expected relationship between case volume and mortality rates could not be established. The completeness of data and low numbers of procedures per surgeon are major concerns. Additional outcome metrics should be utilized to assess performance quality. Failure to Rescue approach should be explored and utilized. It is crucial to have more rigorous and streamlined methods for data collection and case ascertainment to present to the public reliable, complete and relevant data.
自 2013 年以来，英国公布了每位外科医生和国民保健署信托基金在进行择期结直肠癌手术后的结果。公众可以在线查看结直肠切除术后 90 天的手术死亡率。
本研究旨在评估已发表数据的质量。它还旨在发现该数据是否会显示出病例量与术后 90 天死亡率之间的预期反比关系。
术后 90 天死亡率数据取自英国结直肠外科学会（ACPGBI）网站。根据病例量对外科医生和信托基金进行分类。分析了信托基金和外科医生层面数据的完整性。所有统计分析均使用社会科学统计软件包（SPSS，版本 23，IBM，Armonk，NY）进行。
788 名结直肠外科医生在 5 年期间（2010 年 4 月 1 日至 2015 年 3 月 31 日）在 143 家医院进行了 73842 例结直肠癌切除术。结直肠切除术后 90 天的全国平均死亡率为 2.6%。当死亡率与外科医生或信托基金的量相关时，未发现显著影响。与信托基金分析中包含的手术数量相比，在个体外科医生水平分析中存在 3874 名患者的缺失数据（73842 例与 69968 例）。约三分之一的医院（n=43）的病例确定率低于 90%。在 788 名外科医生中，只有两名外科医生的死亡率超出“漏斗极限”。
无法确定病例量与死亡率之间的预期关系。数据的完整性和每位外科医生的手术数量低是主要关注点。应利用其他预后指标来评估绩效质量。应探索并利用“救援失败”方法。至关重要的是，要有更严格和简化的数据收集和病例确定方法，以便向公众提供可靠、完整和相关的数据。
