title: Is benchmarking possible in audit of early outcomes after operations for head and neck cancer?
abstract: There is a need for a validated means of adjusting for case mix in morbidity audits of patients with cancer of the head and neck. To address this, we did a multicentre audit of 3 U.K. NHS cancer networks that treat patients with head and neck cancer, to compare the incidence of early adverse postoperative outcomes and to develop a means of adjusting for case mix. We did a retrospective and prospective audit of the case notes of 901 consecutive patients who had 1034 operations for squamous cell carcinoma (SCC) of the head and neck under general anaesthesia at 3 NHS hospitals. Analysis of raw data showed postoperative 30-day mortality (n=17) to be consistent between sites (1.7%-1.9%) but 30-day complication rates varied more (34%-49%). Logistic regression models predicting morbidity discriminated well (area under the curve 0.74-0.76). Adjusted morbidity rates for the 3 units were compared on a funnel plot with 95% and 99% confidence intervals to account for random variation. It is possible to benchmark surgical performance by focusing on early postoperative outcomes in head and neck surgery. Morbidity is common and usually has a considerable impact on recovery, bed occupancy, cost, and the patient's perception of the quality of care.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK. Electronic address: dft1@doctors.org.uk.
authors.forename: David
authors.initials: D
authors.lastname: Tighe
authors.affiliation: Dept of Informatics, King's College Hospital, London, UK. Electronic address: Isabel.sassoon@kcl.ac.uk.
authors.forename: Isabel
authors.initials: I
authors.lastname: Sassoon
authors.affiliation: Dept of Oral & Maxillofacial Surgery, Guys' Hospital, London, UK. Electronic address: abigailkwok@hotmail.co.uk.
authors.forename: A
authors.initials: A
authors.lastname: Kwok
authors.affiliation: Oral & Maxillofacial Surgery, Guys' Hospital, London, UK. Electronic address: Mark.mcgurk@kcl.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: McGurk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001509:Bed Occupancy; D019985:Benchmarking; D016063:Blood Loss, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D020379:Risk Adjustment; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Audit; Benchmarking; Case-mix adjustment; HNSCC; Morbidity; Mortality; Performance; Surgical Outcomes