title: Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study.
abstract: To explore the impact of risk-adjustment on surgical complication rates (CRs) for benchmarking gynaecological oncology centres.
  
  
  
  Prospective cohort study.
  
  
  
  Ten UK accredited gynaecological oncology centres.
  
  
  
  Women undergoing major surgery on a gynaecological oncology operating list.
  
  
  
  Patient co-morbidity, surgical procedures and intra-operative (IntraOp) complications were recorded contemporaneously by surgeons for 2948 major surgical procedures. Postoperative (PostOp) complications were collected from hospitals and patients. Risk-prediction models for IntraOp and PostOp complications were created using penalised (lasso) logistic regression using over 30 potential patient/surgical risk factors.
  
  
  
  Observed and risk-adjusted IntraOp and PostOp CRs for individual hospitals were calculated. Benchmarking using colour-coded funnel plots and observed-to-expected ratios was undertaken.
  
  
  
  Overall, IntraOp CR was 4.7% (95% CI 4.0-5.6) and PostOp CR was 25.7% (95% CI 23.7-28.2). The observed CRs for all hospitals were under the upper 95% control limit for both IntraOp and PostOp funnel plots. Risk-adjustment and use of observed-to-expected ratio resulted in one hospital moving to the >95-98% CI (red) band for IntraOp CRs. Use of only hospital-reported data for PostOp CRs would have resulted in one hospital being unfairly allocated to the red band. There was little concordance between IntraOp and PostOp CRs.
  
  
  
  The funnel plots and overall IntraOp (≈5%) and PostOp (≈26%) CRs could be used for benchmarking gynaecological oncology centres. Hospital benchmarking using risk-adjusted CRs allows fairer institutional comparison. IntraOp and PostOp CRs are best assessed separately. As hospital under-reporting is common for postoperative complications, use of patient-reported outcomes is important.
  
  
  
  Risk-adjusted benchmarking of surgical complications for ten UK gynaecological oncology centres allows fairer comparison.
authors.affiliation: Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Burnell
authors.affiliation: Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Iyer
authors.affiliation: Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Gentry-Maharaj
authors.affiliation: East Kent Gynaecological Oncology Centre, Queen Elizabeth the Queen Mother Hospital, Margate, UK.
authors.forename: A
authors.initials: A
authors.lastname: Nordin
authors.affiliation: Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Liston
authors.affiliation: Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK.|Department of Gynaecological Cancer, Barts Cancer Centre, Barts and the London NHS Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Manchanda
authors.affiliation: Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, UK.
authors.forename: N
authors.initials: N
authors.lastname: Das
authors.affiliation: Department of Gynaecological Oncology, Cheltenham General Hospital, Cheltenham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Gornall
authors.affiliation: Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Beardmore-Gray
authors.affiliation: Department of Gynaecological Oncology, Cheltenham General Hospital, Cheltenham, UK.
authors.forename: K
authors.initials: K
authors.lastname: Hillaby
authors.affiliation: Department of Obstetrics and Gynaecology, BetsiCadwaladr University Health Board, Bangor, UK.
authors.forename: S
authors.initials: S
authors.lastname: Leeson
authors.affiliation: Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK.
authors.forename: A
authors.initials: A
authors.lastname: Linder
authors.affiliation: Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, UK.
authors.forename: A
authors.initials: A
authors.lastname: Lopes
authors.affiliation: Public Health England, Sheffield, UK.
authors.forename: D
authors.initials: D
authors.lastname: Meechan
authors.affiliation: Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Mould
authors.affiliation: Pan Birmingham Gynaecological Cancer Centre, Birmingham City Hospital, Birmingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Nevin
authors.affiliation: Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Olaitan
authors.affiliation: Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK.
authors.forename: B
authors.initials: B
authors.lastname: Rufford
authors.affiliation: Department of Gynaecological Oncology, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: S
authors.initials: S
authors.lastname: Shanbhag
authors.affiliation: Public Health England, Sheffield, UK.
authors.forename: A
authors.initials: A
authors.lastname: Thackeray
authors.affiliation: Department of Gynaecological Oncology, Lancashire Teaching Hospitals NHS Foundation trust, Royal Preston Hospital, Preston, UK.
authors.forename: N
authors.initials: N
authors.lastname: Wood
authors.affiliation: Department of Gynaecological Cancer, Barts Cancer Centre, Barts and the London NHS Trust, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Ryan
authors.affiliation: Department of Women's Cancer, Gynaecological Cancer Research Centre, Institute for Women's Health, University College London, London, UK.
authors.forename: U
authors.initials: U
authors.lastname: Menon
mesh_terms: D000328:Adult; D000368:Aged; D019985:Benchmarking / Q000379:methods*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D020379:Risk Adjustment / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: UKGOSOC; Benchmarking; centres; comparison; complications; gynaecological oncology; risk adjustment; surgery