title: Textbook outcome as a composite measure in oesophagogastric cancer surgery.
abstract: BACKGROUND
  Quality assurance is acknowledged as a crucial factor in the assessment of oncological surgical care. The aim of this study was to develop a composite measure of multiple outcome parameters defined as 'textbook outcome', to assess quality of care for patients undergoing oesophagogastric cancer surgery.
  
  
  METHODS
  Patients with oesophagogastric cancer, operated on with the intent of curative resection between 2011 and 2014, were identified from a national database (Dutch Upper Gastrointestinal Cancer Audit). Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. Hospital variation in textbook outcome was analysed after adjustment for case-mix factors.
  
  
  RESULTS
  In total, 2748 patients with oesophageal cancer and 1772 with gastric cancer were included in this study. A textbook outcome was achieved in 29·7 per cent of patients with oesophageal cancer and 32·1 per cent of those with gastric cancer. Adjusted textbook outcome rates varied from 8·5 to 52·4 per cent between hospitals. The outcome parameter 'at least 15 lymph nodes examined' had the greatest negative impact on a textbook outcome both for patients with oesophageal cancer and for those with gastric cancer.
  
  
  CONCLUSIONS
  Most patients did not achieve a textbook outcome and there was wide variation between hospitals.
authors.affiliation: Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.|Department of General Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: L A D
authors.initials: LA
authors.lastname: Busweiler
authors.affiliation: Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.|Department of General Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: Schouwenburg
authors.affiliation: Department of General Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: M I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.affiliation: Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: N E
authors.initials: NE
authors.lastname: Kolfschoten
authors.affiliation: Department of Medical Oncology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: P C
authors.initials: PC
authors.lastname: de Jong
authors.affiliation: Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Rozema
authors.affiliation: Department of General Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: B P L
authors.initials: BP
authors.lastname: Wijnhoven
authors.affiliation: Department of General Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
authors.affiliation: Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.|Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.affiliation: Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: van Sandick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality / Q000592:standards; D005260:Female; D005743:Gastrectomy / Q000401:mortality / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008197:Lymph Node Excision / Q000401:mortality / Q000592:standards; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality / Q000592:standards; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D011787:Quality of Health Care; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult