Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study

BJOG. 2016 Dec;123(13):2171-2180. doi: 10.1111/1471-0528.13994. Epub 2016 Mar 22.

Abstract

Objective: To explore the impact of risk-adjustment on surgical complication rates (CRs) for benchmarking gynaecological oncology centres.

Design: Prospective cohort study.

Setting: Ten UK accredited gynaecological oncology centres.

Population: Women undergoing major surgery on a gynaecological oncology operating list.

Methods: Patient co-morbidity, surgical procedures and intra-operative (IntraOp) complications were recorded contemporaneously by surgeons for 2948 major surgical procedures. Postoperative (PostOp) complications were collected from hospitals and patients. Risk-prediction models for IntraOp and PostOp complications were created using penalised (lasso) logistic regression using over 30 potential patient/surgical risk factors.

Main outcome measures: Observed and risk-adjusted IntraOp and PostOp CRs for individual hospitals were calculated. Benchmarking using colour-coded funnel plots and observed-to-expected ratios was undertaken.

Results: Overall, IntraOp CR was 4.7% (95% CI 4.0-5.6) and PostOp CR was 25.7% (95% CI 23.7-28.2). The observed CRs for all hospitals were under the upper 95% control limit for both IntraOp and PostOp funnel plots. Risk-adjustment and use of observed-to-expected ratio resulted in one hospital moving to the >95-98% CI (red) band for IntraOp CRs. Use of only hospital-reported data for PostOp CRs would have resulted in one hospital being unfairly allocated to the red band. There was little concordance between IntraOp and PostOp CRs.

Conclusion: The funnel plots and overall IntraOp (≈5%) and PostOp (≈26%) CRs could be used for benchmarking gynaecological oncology centres. Hospital benchmarking using risk-adjusted CRs allows fairer institutional comparison. IntraOp and PostOp CRs are best assessed separately. As hospital under-reporting is common for postoperative complications, use of patient-reported outcomes is important.

Tweetable abstract: Risk-adjusted benchmarking of surgical complications for ten UK gynaecological oncology centres allows fairer comparison.

Keywords: UKGOSOC; Benchmarking; centres; comparison; complications; gynaecological oncology; risk adjustment; surgery.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Benchmarking / methods*
  • Cohort Studies
  • Comorbidity
  • Female
  • Genital Neoplasms, Female* / epidemiology
  • Genital Neoplasms, Female* / surgery
  • Gynecologic Surgical Procedures / adverse effects*
  • Gynecologic Surgical Procedures / methods
  • Gynecologic Surgical Procedures / statistics & numerical data
  • Humans
  • Middle Aged
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / statistics & numerical data
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Prevalence
  • Prospective Studies
  • Risk Adjustment / methods
  • Risk Adjustment / statistics & numerical data
  • Risk Assessment / methods
  • Risk Factors
  • United Kingdom / epidemiology