TY - JOUR
T1 - Textbook outcome as a composite outcome measure to compare hospital performances regarding cytoreductive surgery for ovarian cancer
T2 - A nationwide population-based study.
AU - Algera, M. D.
AU - Slangen, B. F. M.
AU - van Driel, W. J.
AU - Wouters, M. W. J. M.
AU - Kruitwagen, R. F. P. M.
AU - Participants of the Dutch Gynecological Oncology Audit Collaborator Group
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Objective. Textbook outcome (TO) is a composite outcome measure used in surgical oncology to compare hos-pital outcomes using multiple quality indicators. This study aimed to develop TO as an outcome measure to assess healthcare quality for patients undergoing cytoreductive surgery (CRS) for advanced-stage ovarian cancer.Methods. This population-based study included all CRS for FIGO IIIC-IVB primary ovarian cancer registered in the Netherlands between 2017 and 2020. The primary outcome was TO, defined as a complete CRS, combined with the absence of 30-day mortality, severe complications, and prolonged length of admission (>= ten days). Delayed start of adjuvant chemotherapy (>= six weeks) was not included in TO because of missing data. Logistic regressions were used to assess the association of case-mix factors with TO. Hospital variation was displayed using funnel plots.Results. A total of 1909 CRS were included, of which 1434 were interval CRS and 475 were primary CRS. TO was achieved in 54% of the interval CRS cohort and 47% of the primary CRS cohort. Macroscopic residual disease after CRS was the most important factor for not achieving TO. Age >= 70 was associated with lower TO rates in mul-tivariable logistic regressions. TO rates ranged from 40% to 69% between hospitals in the interval CRS cohort and 22% to 100% in the primary CRS cohort. In both analyses, one hospital had significantly lower TO rates (different hospitals). Case-mix adjustment significantly affected TO rates in the primary CRS analysis.Conclusions. TO is a suitable composite outcome measure to detect hospital variation in healthcare quality for patients with advanced-stage ovarian cancer undergoing CRS. Case-mix adjustment improves the accuracy of the hospital comparison.(c) 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
AB - Objective. Textbook outcome (TO) is a composite outcome measure used in surgical oncology to compare hos-pital outcomes using multiple quality indicators. This study aimed to develop TO as an outcome measure to assess healthcare quality for patients undergoing cytoreductive surgery (CRS) for advanced-stage ovarian cancer.Methods. This population-based study included all CRS for FIGO IIIC-IVB primary ovarian cancer registered in the Netherlands between 2017 and 2020. The primary outcome was TO, defined as a complete CRS, combined with the absence of 30-day mortality, severe complications, and prolonged length of admission (>= ten days). Delayed start of adjuvant chemotherapy (>= six weeks) was not included in TO because of missing data. Logistic regressions were used to assess the association of case-mix factors with TO. Hospital variation was displayed using funnel plots.Results. A total of 1909 CRS were included, of which 1434 were interval CRS and 475 were primary CRS. TO was achieved in 54% of the interval CRS cohort and 47% of the primary CRS cohort. Macroscopic residual disease after CRS was the most important factor for not achieving TO. Age >= 70 was associated with lower TO rates in mul-tivariable logistic regressions. TO rates ranged from 40% to 69% between hospitals in the interval CRS cohort and 22% to 100% in the primary CRS cohort. In both analyses, one hospital had significantly lower TO rates (different hospitals). Case-mix adjustment significantly affected TO rates in the primary CRS analysis.Conclusions. TO is a suitable composite outcome measure to detect hospital variation in healthcare quality for patients with advanced-stage ovarian cancer undergoing CRS. Case-mix adjustment improves the accuracy of the hospital comparison.(c) 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
KW - Textbook outcome
KW - Advanced-stage ovarian cancer
KW - Cytoreductive surgery
KW - Postoperative complications
KW - Mortality
KW - Complete cytoreduction
KW - Length of hospital stay
KW - Clinical auditing
U2 - 10.1016/j.ygyno.2023.04.021
DO - 10.1016/j.ygyno.2023.04.021
M3 - Article
C2 - 37167897
SN - 0090-8258
VL - 174
SP - 89
EP - 97
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 1
ER -