Quality improvement interventions in surgical oncology: systematic review of international studies

Substantial variation in surgical care and outcomes has been identified by quality assurance initiatives. Quality improvement (QI) interventions have the potential to address these disparities. This paper aimed to assess the types of QI interventions that have been designed, implemented, and evaluated in surgical oncology.

A systematic search of MEDLINE and EMBASE was conducted to identify studies on QI interventions published between January 2000 and September 2025. Studies reporting the impact of the QI intervention on predefined quality deficits in clinical outcomes or care and process measures were selected. Data on study design, QI methodology, quality deficits, intervention types, and outcomes were extracted. Results were summarized using narrative synthesis and appraised using the Cochrane Effective Practice and Organization of Care risk of bias tool.

Of 11 373 studies, 109 were included. The majority were in the USA (48 (44.0%)), followed by Canada (20 (18.3%)), and the UK (11 (10.1%)). The commonest tumour types were gynaecological (22 (20.2%)) and colorectal (20 (18.3%)). The commonest quality deficits addressed were postoperative complications (22 (20.2%)) and prolonged length of stay (12 (11.0%)). One study was conducted globally, 6 nationally, 20 regionally, and 82 locally. Among randomized clinical trials, only 2 of 12 (16%) demonstrated a positive effect compared with 86 of 97 (89%) non-randomized studies. Only 28 (25.7%) studies referenced specific QI methodologies, most commonly the Plan-Do-Study-Act cycle (10 (9.2%)). QI interventions encompassed care pathway standardization, perioperative care bundles, audit, and feedback, combined with surgical skills workshops and digital tools, including checklists, and care coordination initiatives. Most studies were uncontrolled before-and-after studies (74 (67.9%)) and were classified as low quality.

There are limited high-quality evaluations of QI interventions in the literature. Key gaps include interventions to improve equitable access to surgical care. Comprehensive QI studies leveraging large-scale, multidisciplinary collaborations and robust methodologies are needed to realize potential gains in surgical oncology care.