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Is Textbook Oncologic Outcome a Valid Hospital-Quality Metric after High-Risk Surgical Oncology Procedures?

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

“Textbook oncologic outcome” (TOO) is a composite quality measure representing the “ideal” outcome for patients undergoing cancer surgery. This study sought to assess the validity of TOO as a metric to evaluate hospital quality.

Methods

Patients who underwent curative-intent resection of gastric, pancreatic, colon, rectal, lung, esophageal, bladder, or ovarian cancer were identified in the National Cancer Database (2006–2017). Cancer site-specific TOO was defined as adequate lymph node yield, R0 resection, non-length-of-stay outlier, no hospital readmission, and receipt of guideline-concordant chemotherapy and/or radiation. Mixed-effects analyses estimated the adjusted TOO rate for each hospital stratified by cancer site. The association between hospital adjusted TOO rates and 5-year overall survival was assessed using mixed-effects Cox proportional hazards analyses.

Results

Among 852,988 cancer resections, the TOO rate varied across cancer sites as follows: stomach (31.8%), pancreas (25%), colon (66.9%), rectum (33.6%), lung (35.1%), esophagus (31.2%), bladder (43%), and ovary (44.7%). After characterization of adjusted hospital TOO rates into quintiles, an incremental improvement in overall survival was observed, with higher adjusted TOO rates. Similarly, with the adjusted hospital TOO rate treated as a continuous variable, there was a significant 4% to 12% improvement in overall survival for every 10% increase in the adjusted hospital TOO rate for gastric (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.85–0.91), pancreatic (HR, 0.90; 95% CI, 0.88–0.93), colon (0.93; 95% CI, 0.91–0.94), rectal (HR, 0.90; 95% CI, 0.87–0.93), lung (HR, 0.96; 95% CI, 0.95–0.97), esophageal (HR, 0.93; 95% CI, 0.90–0.95), bladder (HR, 0.94; 95% CI, 0.91–0.97), and ovarian (HR, 0.96; 95% CI, 0.94–0.98) cancer.

Conclusions

A direct association exists between adjusted hospital TOO rates and survival after high-risk cancer procedures. As a valid hospital metric, TOO can be used to compare the overall quality of cancer care across hospitals.

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Author information

Author notes

  1. Christopher T. Aquina and Ahmad Hamad are co-first authors.

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Christopher T. Aquina MD, MPH, Ahmad Hamad MD, Jordan M. Cloyd MD, Allan Tsung MD, Timothy M. Pawlik MD, MPH, PhD & Aslam Ejaz MD, MPH

  2. Department of Surgery, Rush University Medical Center, Chicago, IL, USA

    Adan Z. Becerra PhD

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  1. Christopher T. Aquina MD, MPH
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  2. Ahmad Hamad MD
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  3. Adan Z. Becerra PhD
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  4. Jordan M. Cloyd MD
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  7. Aslam Ejaz MD, MPH
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Correspondence to Christopher T. Aquina MD, MPH.

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Virtual forum session oral presentation at the Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care on March 18th, 2021.

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Aquina, C.T., Hamad, A., Becerra, A.Z. et al. Is Textbook Oncologic Outcome a Valid Hospital-Quality Metric after High-Risk Surgical Oncology Procedures?. Ann Surg Oncol 28, 8028–8045 (2021). https://doi.org/10.1245/s10434-021-10478-0

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