Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Br J Surg. 2022 Nov 22;109(12):1274-1281. doi: 10.1093/bjs/znac300.
Benchmark comparisons in surgery allow identification of gaps in the quality of care provided. The aim of this study was to determine quality thresholds for high (HAR) and low (LAR) anterior resections in colorectal cancer surgery by applying the concept of benchmarking.
This 5-year multinational retrospective study included patients who underwent anterior resection for cancer in 19 high-volume centres on five continents. Benchmarks were defined for 11 relevant postoperative variables at discharge, 3 months, and 6 months (for LAR). Benchmarks were calculated for two separate cohorts: patients without (ideal) and those with (non-ideal) outcome-relevant co-morbidities. Benchmark cut-offs were defined as the 75th percentile of each centre's median value.
A total of 3903 patients who underwent HAR and 3726 who had LAR for cancer were analysed. After 3 months' follow-up, the mortality benchmark in HAR for ideal and non-ideal patients was 0.0 versus 3.0 per cent, and in LAR it was 0.0 versus 2.2 per cent. Benchmark results for anastomotic leakage were 5.0 versus 6.9 per cent for HAR, and 13.6 versus 11.8 per cent for LAR. The overall morbidity benchmark in HAR was a Comprehensive Complication Index (CCI®) score of 8.6 versus 14.7, and that for LAR was CCI® score 11.9 versus 18.3.
Regular comparison of individual-surgeon or -unit outcome data against benchmark thresholds may identify gaps in care quality that can improve patient outcome.
手术中的基准比较可以确定提供的护理质量差距。本研究旨在通过应用基准化的概念确定结直肠癌手术中高（HAR）和低（LAR）前切除术的质量阈值。
这是一项为期 5 年的多国回顾性研究，纳入了来自五个大陆 19 个高容量中心接受前切除术治疗癌症的患者。在出院时、3 个月和 6 个月（对于 LAR），为 11 个相关术后变量定义了基准。为两个独立队列计算了基准：无（理想）和有（非理想）与结果相关的合并症的患者。基准截止值定义为每个中心中位数的第 75 个百分位数。
分析了 3903 例接受 HAR 和 3726 例接受 LAR 治疗癌症的患者。在 3 个月的随访后，HAR 中理想和非理想患者的死亡率基准为 0.0 与 3.0%，而 LAR 中为 0.0 与 2.2%。HAR 吻合口漏的基准结果为 5.0 与 6.9%，而 LAR 为 13.6 与 11.8%。HAR 的总体发病率基准为综合并发症指数（CCI®）评分为 8.6 与 14.7，而 LAR 为 CCI®评分为 11.9 与 18.3。
定期将个别外科医生或单位的结果数据与基准阈值进行比较，可能会发现护理质量差距，从而改善患者的结果。
