Risk adjusted benchmarking of abdominoperineal excision for rectal adenocarcinoma in the context of the Belgian PROCARE improvement project

Freddy Penninckx ¹, Steffen Fieuws , Koen Beirens

⁰Department of Abdominal Surgery, UZ Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. freddy.penninckx@uzleuven.be

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April 25, 2012

View abstract on PubMed

Summary

Abdominoperineal excision (APE) rates vary significantly between surgical centers. Risk adjustment and including Hartmann resections (HR) are crucial for accurate rectal cancer surgery performance assessment.

Area Of Science

Colorectal Surgery
Surgical Quality Improvement
Oncology Outcomes

Background

Abdominoperineal excision (APE) is a key quality indicator in rectal cancer surgery.
APE rates have been criticized for not accounting for patient-specific factors.
Benchmarking surgical performance requires robust risk adjustment.

Purpose Of The Study

To evaluate variability in APE rates among Belgian centers before and after risk adjustment.
To assess the impact of merging APE and Hartmann resection (HR) rates on performance benchmarking.
To identify factors influencing APE rates in rectal cancer surgery.

Main Methods

Analysis of data from 3197 patients undergoing elective rectal resection across 59 centers.
Risk adjustment for factors including age, gender, ASA score, tumor location, invasion depth, and incontinence.
Comparison of APE rates and merged APE/HR rates before and after adjustment.

Main Results

Overall APE rate was 21.1%, with significant center-to-center variation (p<0.0001).
APE rates increased to 45.8% for lower rectal third cancers, with greater inter-center variability.
Risk adjustment altered outlier identification; merging APE and HR identified different outlier centers.

Conclusions

Significant variation exists in APE rates, even after risk adjustment.
Incorporating confounding factors and merging HR with APE rates are essential for accurate performance evaluation.
This study highlights the importance of nuanced approaches to surgical quality assessment in rectal cancer.

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