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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/16996

Title: Risk adjusted benchmarking of abdominoperineal excision for rectal adenocarcinoma in the context of the Belgian PROCARE improvement project
Authors: Penninckx, Freddy
Fieuws, Steffen
Beirens, Koen
Demetter, Pieter
Ceelen, Wim
Kartheuser, Alex
Molle, Gaetan
Van de Stadt, Jean
Vindevoghel, Koen
Van Eycken, Elizabeth
Issue Date: 2013
Publisher: BMJ PUBLISHING GROUP
Citation: GUT, 62 (7), p. 1005-1011
Abstract: Objective The abdominoperineal excision (APE) rate, a quality of care indicator in rectal cancer surgery, has been criticised if not adjusted for confounding factors. This study evaluates variability in APE rate between centres participating in PROCARE, a Belgian improvement initiative, before and after risk adjustment. It also explores the effect of merging the Hartmann resections (HR) rate with that of APE on benchmarking. Design Data of 3197 patients who underwent elective radical resection for invasive rectal adenocarcinoma up to 15 cm were registered between January 2006 and March 2011 by 59 centres, each with at least 10 patients in the registry. Variability of APE or merged APE/HR rates between centres was analysed before and after adjustment for gender, age, ASA score (3 or more), tumour level (rectal third), depth of tumour invasion (cT4) and preoperative incontinence. Results The overall APE rate was 21.1% (95% CI 19.7 to 22.5%). Significant variation of the APE rate was observed before and after risk adjustment (p<0.0001). For cancers in the lower rectal third, the overall APE rate increased to 45.8% (95% CI 43.1 to 48.5%). Also, variation between centres increased. Risk adjustment influenced the identification of outliers. HR was performed in only 2.6% of patients. However, merging of risk adjusted APE and HR rates identified other centres with outlying definitive colostomy rates than APE rate alone. Conclusion Significant variation of the APE rate was observed. Adjustment for confounding factors as well as merging HR with APE rates were found to be important for the assessment of performances.
Notes: [Penninckx, Freddy] Univ Hosp Gasthuisberg, Dept Abdominal Surg, B-3000 Louvain, Belgium. [Fieuws, Steffen] Katholieke Univ Leuven, I Biostat, Louvain, Belgium. [Fieuws, Steffen] Univ Hasselt, I Biostat, Louvain, Belgium. [Beirens, Koen; Van Eycken, Elizabeth] Belgian Canc Registry, Brussels, Belgium. [Demetter, Pieter] Erasme Univ Hosp, Dept Pathol, B-1070 Brussels, Belgium. [Ceelen, Wim] Univ Hosp, Dept Surg, Ghent, Belgium. [Kartheuser, Alex] Clin Univ St Luc, Colorectal Surg Unit, B-1200 Brussels, Belgium. [Molle, Gaetan] Hop Jolimont, Dept Digest Surg, Jolimont, Belgium. [Van de Stadt, Jean] Erasme Univ Hosp, Dept Surg, B-1070 Brussels, Belgium. [Vindevoghel, Koen] OLV Lourdes Ziekenhuis, Dept Surg, Waregem, Belgium.
URI: http://hdl.handle.net/1942/16996
DOI: 10.1136/gutjnl-2011-301941
ISI #: 000319975900010
ISSN: 0017-5749
Category: A1
Type: Journal Contribution
Validation: ecoom, 2014
Appears in Collections: Research publications

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