Textbook outcome as a composite measure in oesophagogastric cancer surgery

BackgroundQuality assurance is acknowledged as a crucial factor in the assessment of oncological surgical care. The aim of this study was to develop a composite measure of multiple outcome parameters defined as textbook outcome', to assess quality of care for patients undergoing oesophagogastric cancer surgery. MethodsPatients with oesophagogastric cancer, operated on with the intent of curative resection between 2011 and 2014, were identified from a national database (Dutch Upper Gastrointestinal Cancer Audit). Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. Hospital variation in textbook outcome was analysed after adjustment for case-mix factors. ResultsIn total, 2748 patients with oesophageal cancer and 1772 with gastric cancer were included in this study. A textbook outcome was achieved in 297 per cent of patients with oesophageal cancer and 321 per cent of those with gastric cancer. Adjusted textbook outcome rates varied from 85 to 524 per cent between hospitals. The outcome parameter at least 15 lymph nodes examined' had the greatest negative impact on a textbook outcome both for patients with oesophageal cancer and for those with gastric cancer. ConclusionMost patients did not achieve a textbook outcome and there was wide variation between hospitals. Novel approach to quality assessment