Division of Cancer and Genetics, Cardiff University, Cardiff, UK.
Department of Surgery, University Hospital of Wales, Cardiff, UK.
BJS Open. 2020 Feb;4(1):91-100. doi: 10.1002/bjs5.50230. Epub 2019 Nov 4.
Surgeon-level operative mortality is widely seen as a measure of quality after gastric and oesophageal resection. This study aimed to evaluate this alongside a compound-level outcome analysis.
Consecutive patients who underwent treatment including surgery delivered by a multidisciplinary team, which included seven specialist surgeons, were studied. The primary outcome was death within 30 days of surgery; secondary outcomes were anastomotic leak, Clavien-Dindo morbidity score, lymph node harvest, circumferential resection margin (CRM) status, disease-free (DFS), and overall (OS) survival.
The median number of annual resections per surgeon was 10 (range 5-25), compared with 14 (5-25) for joint consultant teams (P = 0·855). The median annual surgeon-level mortality rate was 0 (0-9) per cent versus an overall network annual operative mortality rate of 1·8 (0-3·7) per cent. Joint consultant team procedures were associated with fewer operative deaths (0·5 per cent versus 3·4 per cent at surgeon level; P = 0·027). The median surgeon anastomotic leak rate was 12·4 (range 9-20) per cent (P = 0·625 versus the whole surgical range), overall morbidity 46·5 (31-60) per cent (P = 0·066), lymph node harvest 16 (9-29) (P < 0·001), CRM positivity 32·0 (16-46) per cent (P = 0·003), 5-year DFS rate 44·8 (29-60) per cent and OS rate 46·5 (35-53) per cent. No designated metrics were independently associated with DFS or OS in multivariable analysis.
Annual surgeon-level metrics demonstrated wide variations (fivefold), but these performance metrics were not associated with survival.
外科医生层面的手术死亡率被广泛认为是胃和食管切除术后质量的衡量标准。本研究旨在评估这一指标，并进行复合层面的结果分析。
研究纳入了由多学科团队治疗的连续患者，该团队包括 7 名专科外科医生。主要结局是手术 30 天内死亡；次要结局包括吻合口漏、Clavien-Dindo 并发症评分、淋巴结清扫、环周切缘（CRM）状态、无病生存（DFS）和总生存（OS）。
每位外科医生每年的中位手术例数为 10 例（范围 5-25 例），而联合顾问团队的中位手术例数为 14 例（范围 5-25 例）（P=0.855）。外科医生层面的中位年度死亡率为 0（0-9）%，而整个网络的手术年度死亡率为 1.8（0-3.7）%。联合顾问团队的手术与较低的手术死亡率相关（外科医生层面为 0.5%，而联合顾问团队为 3.4%；P=0.027）。外科医生吻合口漏率的中位数为 12.4（9-20）%（P=0.625 与整个手术范围相比），总体并发症发生率为 46.5（31-60）%（P=0.066），淋巴结清扫中位数为 16（9-29）个（P<0.001），CRM 阳性率为 32.0（16-46）%（P=0.003），5 年 DFS 率为 44.8（29-60）%，OS 率为 46.5（35-53）%。多变量分析中，没有指定的指标与 DFS 或 OS 独立相关。
外科医生层面的年度指标存在很大差异（五倍），但这些绩效指标与生存无关。
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