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Use of a national registry to define a composite quality metric for rectal cancer


Background

Quality assessment in oncologic surgery has traditionally involved reporting discrete
metrics that may be difficult for patients and referring providers to interpret. We
define a composite quality metric (CQM) for resection in rectal cancer.

Methods

We queried the National Cancer Database to identify patients undergoing low anterior
resection for clinical stage II-III rectal adenocarcinoma between 2010 and 2017. CQM
was defined as appropriate neoadjuvant therapy, margin-negative resection, appropriate
lymph node assessment, postoperative length of stay (LOS) < 75th percentile, and no
30-day readmission or mortality.

Results

19,721 patients met inclusion criteria; 8,083 (41%) had a CQM. The most common reasons
for failure to achieve CQM: inadequate node assessment (27%), prolonged LOS (26%).
On Cox modeling, CQM (aHR 0.70, 95% CI [0.66, 0.75]) was associated with improved
overall survival.

Conclusion

CQM is independently associated with improved survival in rectal cancer and may be
an effective measure of quality.



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