Standard outcome indicators after colon cancer resection. Creation of a nomogram for autoevaluation

Abstract

Introduction: Lately there has been an increasing interest in identifying quality standards in different pathologies, among them colon cancer due to its great prevalence. The main goal of this study is to define the quality standards of colon cancer surgery based on a large prospective national study dataset.

Methods: Data from the prospective national study ANACO were used. This study included a consecutive series of patients operated on for colon cancer in 52 Spanish hospitals (2011-2012). Centers with less than 30 patients were excluded. The present analysis finally included 42 centers (2975 patients). Based on the results obtained in 4main indicators from each hospital (anastomotic leak, lymph-nodes found in the specimen, mortality and length of stay), a nomogram that allows the evaluation of the performance of each center was designed. Standard results for further 5 intraoperative and 5 postoperative quality indicators were also reported.

Results: Median of anastomotic leak and mortality rate was 8.5% (25^th-75^th percentiles 6.1%-12.4%) and 2.5% (25^th-75^th percentiles 0.6%-4.7%), respectively. Median number of nodes found in the surgical specimen was 15,1 (25^th-75^th percentiles 18-14 nodes). Median length of postoperative stay was 7.7 days (25^th-75^th percentiles 6.9-9.2 days). Based on these data, a nomogram for hospital audit was created.

Conclusions: Standard surgical results after colon cancer surgery were defined, creating a tool for auto-evaluation and allowing each center to identify areas for improvement in the surgical treatment of colon cancer.

Keywords: Cirugía de colon; Colon surgery; Colonic neoplasms; Estándares de referencia; Evaluación de resultados; Indicadores de calidad; Neoplasias de colon; Outcome assessment; Quality indicators; Reference standards.