Abstract
Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors. Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians' judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores. Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001). This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care.
Highlights
With nearly 60% of patients aged above 70 years and more than 35% of patients aged 75 years and over, colorectal cancer is predominantly a disease of older adults [1]
Technical efficiency evaluation of colorectal cancer care quality indicators published by the Dutch Health and Youth Care Inspectorate are available from the website of the Dutch Health and Youth Care Inspectorate: https://www.dhd.nl/productendiensten/omniq/Paginas/Databestanden-BasissetMSZ.aspx (Basisset MSZ 2017 and Basisset MSZ 2018)
Data on postoperative complications are obtained from the Dutch Surgical Colorectal Audit and are limited available on request against payment: https://dica.nl/dcra/ onderzoek
Summary
With nearly 60% of patients aged above 70 years and more than 35% of patients aged 75 years and over, colorectal cancer is predominantly a disease of older adults [1]. Regardless of age or number of co-morbid conditions, surgery is the cornerstone for curative treatment in patients with colorectal cancer [4]. Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors. Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; we enable the publication of all of the content of peer review and author responses alongside final, published articles.
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