MTL, a composite measure for objectively profiling hospitals on surgical performance in colorectal cancer surgery

Julia Hardt,Stefan Post,H. J. Buhr,C. Klinger,Fabian Doyon

doi:10.1007/s00384-019-03273-7

Abstract

PurposeMTL is a composite outcome measure based on routine administrative data defined as (a) postoperative mortality and/or (b) postoperative transfer to another hospital and/or (c) length of hospital stay ≥ the prespecified time period. Aim of the present study was to investigate MTL for profiling hospitals on surgical performance in colorectal cancer surgery, using data from the national registers of the German Society of General and Visceral Surgery (DGAV) and to determine the time interval for length of stay with the highest accuracy regarding major complications (Clavien-Dindo grade ≥ 3).MethodsAll patients undergoing colorectal cancer resection between January 2010 and February 2017 were included. MTL rates were calculated and compared to well-established single outcome measures using multivariate regression analysis. For each outcome measure, postoperative complications were tested regarding their predictability.ResultsData from 14,978 patients were analyzed. Length of stay was significantly prolonged if postoperative complications occurred (p < 0.0001). Thirty-day mortality and the indication for a transfer to another hospital mainly resulted from cardiopulmonary complications. MTL occurs significantly more often than any of the single-outcome parameters. The time interval of 22 days demonstrated the highest accuracy regarding severe complications (Clavien-Dindo grade ≥ 3).ConclusionsMTL reflects the complete spectrum of postoperative complications. Compared to individual surgical outcome parameters, MTL may have a better discriminatory power and is therefore suitable to mirror surgical quality. Because of its high accuracy regarding surgical major morbidity, 22 days is the best cut-off for length of stay within the German healthcare system.

Highlights

There is a growing need for quality indicators which reliably and objectively measure the outcome quality of surgical performance and clearly identify high- and low-performing hospitals.Julia Hardt and Fabian Doyon contributed to this work
Most quality improvement projects focus on single-quality indicators, which may not sufficiently mirror overall quality of the surgical performance in the context of colorectal cancer care [2]
To test the recently introduced composite outcome measure MTL with regard to its suitability for profiling hospitals on surgical performance, we analyzed the complete dataset from the colorectal cancer study, documentation, and quality centre (StuDoQ) registers of the German Society of General and Visceral Surgery (DGAV)

Summary

Introduction

There is a growing need for quality indicators which reliably and objectively measure the outcome quality of surgical performance and clearly identify high- and low-performing hospitals.Julia Hardt and Fabian Doyon contributed to this work. There is a growing need for quality indicators which reliably and objectively measure the outcome quality of surgical performance and clearly identify high- and low-performing hospitals. Composite outcome measures combine different quality indicators in one score to increase the reliability of hospital performance assessment. Most quality improvement projects focus on single-quality indicators, which may not sufficiently mirror overall quality of the surgical performance in the context of colorectal cancer care [2]. To test the recently introduced composite outcome measure MTL with regard to its suitability for profiling hospitals on surgical performance, we analyzed the complete dataset from the colorectal cancer study, documentation, and quality centre (StuDoQ) registers of the German Society of General and Visceral Surgery (DGAV). The time interval of 30 days was primarily chosen because a follow up of 30 days is

Methods

Results

Conclusion