title: Validating a benchmarking tool for audit of early outcomes after operations for head and neck cancer.
abstract: INTRODUCTION In 2013 all UK surgical specialties, with the exception of head and neck surgery, published outcome data adjusted for case mix for indicator operations. This paper reports a pilot study to validate a previously published risk adjustment score on patients from separate UK cancer centres. METHODS A case note audit was performed of 1,075 patients undergoing 1,218 operations for head and neck squamous cell carcinoma under general anaesthesia in 4 surgical centres. A logistic regression equation predicting for all complications, previously validated internally at sites A-C, was tested on a fourth external validation sample (site D, 172 operations) using receiver operating characteristic curves, Hosmer-Lemeshow goodness of fit analysis and Brier scores. RESULTS Thirty-day complication rates varied widely (34-51%) between the centres. The predictive score allowed imperfect risk adjustment (area under the curve: 0.70), with Hosmer-Lemeshow analysis suggesting good calibration. The Brier score changed from 0.19 for sites A-C to 0.23 when site D was also included, suggesting poor accuracy overall. CONCLUSIONS Marked differences in operative risk and patient case mix captured by the risk adjustment score do not explain all the differences in observed outcomes. Further investigation with different methods is recommended to improve modelling of risk. Morbidity is common, and usually has a major impact on patient recovery, ward occupancy, hospital finances and patient perception of quality of care. We hope comparative audit will highlight good performance and challenge underperformance where it exists.
authors.affiliation: Queen Victoria Hospital NHS Foundation Trust , UK.
authors.forename: D
authors.initials: D
authors.lastname: Tighe
authors.affiliation: King's College London , Germany.
authors.forename: I
authors.initials: I
authors.lastname: Sassoon
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust , UK.
authors.forename: M
authors.initials: M
authors.lastname: McGurk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Clinical audit; Complications; Outcomes; Squamous cell carcinoma