Using a Lymph Node Count Metric to Identify Underperforming Hospitals After Rectal Cancer Surgery

Area of Science:

• Oncology
• Surgical Quality Improvement
• Health Services Research

Background:

• Benchmarking hospital quality using surgical indicators can improve cancer care in the United States.
• The utility of lymph node count as a quality metric for cancer surgery was investigated.

Purpose of the Study:

• To determine the utility of lymph node count as a quality metric for cancer surgery.
• To assess if hospital quality scores based on lymph node count can identify underperforming hospitals.

Main Methods:

• Retrospective analysis of the California Cancer Registry and statewide inpatient database (2004-2011).
• Inclusion of patients with locally advanced rectal adenocarcinoma who underwent neoadjuvant therapy and resection.
• Hospital quality score defined by the proportion of patients with at least nine lymph nodes examined; high-scoring hospitals had ≥25% of operations with adequate lymph node retrieval.
• Multivariate Cox proportional hazards model used to analyze overall survival, adjusting for multiple covariates.

Main Results:

• 2704 patients treated at 228 hospitals were analyzed.
• High-scoring hospitals (≥9 lymph nodes in ≥25% of operations) showed higher sphincter preservation (P=0.004) and lower complications (P=0.021).
• Care at high-scoring hospitals independently predicted improved overall survival (hazard ratio: 0.74; P=0.003).

Conclusions:

• Hospital quality scores based on lymph node count can effectively identify underperforming hospitals.
• This metric aids in improving cancer surgery quality and patient outcomes.