A new frontier for quality of care in gynecologic oncology surgery: Multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model

Giovanni D. Aletti, Antonio Santillan, Eric L. Eisenhauer, Jae Hu, Giacomo Aletti, Karl C. Podratz, Robert E. Bristow, Dennis S. Chi, William Arthur Cliby

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Objective: To test the feasibility and utility of a risk-adjusted, multicenter outcomes model for ovarian cancer surgery as a tool for quality improvement. Methods: Patient characteristics, intra-operative findings, procedures, and outcomes were assessed in primary advanced stage ovarian cancer cases from 3 independent centers. A surgical complexity score (SCS) was developed to adjust for extent of surgery. Outcomes measures were: 30-day morbidity (sepsis, thrombo-embolic, cardiac, readmission or re-operation), 3-month mortality, length of stay (LOS), and ability to receive chemotherapy. A multivariable risk-adjusted model was developed for all the outcomes. Observed-to-expected (O/E) outcome ratios were calculated from all data. Results: 564 consecutive patients from 3 centers were analyzed. The strongest predictors of 30-day morbidity were endogenous [albumin (p < 0.001) and ASA (p = 0.008)] and complexity of surgery [SCS (p < 0.001)]. Age (p = 0.002) and ASA (p = 0.001) independently predicted mortality. LOS independently correlated with age (p = 0.007), albumin (p = 0.004), SCS (p = 0.002), and stage (p = 0.024). ASA (p < 0.001) and SCS (p = 0.003) both impacted ability to receive chemotherapy. Observed to expected (O/E) ratios for dependent outcome variables were similar for all 3 institutions. Conclusions: We demonstrate the benefits of a national system for studying outcomes in gynecologic surgery using a risk-adjusted model. We specifically find that endogenous patient factors and complexity of surgery are primary drivers of morbidity in ovarian cancer surgery. These data can successfully be used to formulate expected, risk-adjusted rates of complications thus providing a meaningful mechanism to identify areas ripe for quality improvement.

Original languageEnglish (US)
Pages (from-to)99-106
Number of pages8
JournalGynecologic Oncology
Volume107
Issue number1
DOIs
StatePublished - Oct 2007

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Gynecologic Surgical Procedures
Quality of Health Care
Ovarian Neoplasms
Quality Improvement
Morbidity
Albumins
Length of Stay
Drug Therapy
Mortality
Operative Surgical Procedures
Sepsis
Outcome Assessment (Health Care)

Keywords

  • Morbidity
  • Mortality
  • Outcomes
  • Quality of care
  • Risk adjustment model
  • Surgery

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

A new frontier for quality of care in gynecologic oncology surgery : Multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model. / Aletti, Giovanni D.; Santillan, Antonio; Eisenhauer, Eric L.; Hu, Jae; Aletti, Giacomo; Podratz, Karl C.; Bristow, Robert E.; Chi, Dennis S.; Cliby, William Arthur.

In: Gynecologic Oncology, Vol. 107, No. 1, 10.2007, p. 99-106.

Research output: Contribution to journalArticle

Aletti, Giovanni D. ; Santillan, Antonio ; Eisenhauer, Eric L. ; Hu, Jae ; Aletti, Giacomo ; Podratz, Karl C. ; Bristow, Robert E. ; Chi, Dennis S. ; Cliby, William Arthur. / A new frontier for quality of care in gynecologic oncology surgery : Multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model. In: Gynecologic Oncology. 2007 ; Vol. 107, No. 1. pp. 99-106.
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abstract = "Objective: To test the feasibility and utility of a risk-adjusted, multicenter outcomes model for ovarian cancer surgery as a tool for quality improvement. Methods: Patient characteristics, intra-operative findings, procedures, and outcomes were assessed in primary advanced stage ovarian cancer cases from 3 independent centers. A surgical complexity score (SCS) was developed to adjust for extent of surgery. Outcomes measures were: 30-day morbidity (sepsis, thrombo-embolic, cardiac, readmission or re-operation), 3-month mortality, length of stay (LOS), and ability to receive chemotherapy. A multivariable risk-adjusted model was developed for all the outcomes. Observed-to-expected (O/E) outcome ratios were calculated from all data. Results: 564 consecutive patients from 3 centers were analyzed. The strongest predictors of 30-day morbidity were endogenous [albumin (p < 0.001) and ASA (p = 0.008)] and complexity of surgery [SCS (p < 0.001)]. Age (p = 0.002) and ASA (p = 0.001) independently predicted mortality. LOS independently correlated with age (p = 0.007), albumin (p = 0.004), SCS (p = 0.002), and stage (p = 0.024). ASA (p < 0.001) and SCS (p = 0.003) both impacted ability to receive chemotherapy. Observed to expected (O/E) ratios for dependent outcome variables were similar for all 3 institutions. Conclusions: We demonstrate the benefits of a national system for studying outcomes in gynecologic surgery using a risk-adjusted model. We specifically find that endogenous patient factors and complexity of surgery are primary drivers of morbidity in ovarian cancer surgery. These data can successfully be used to formulate expected, risk-adjusted rates of complications thus providing a meaningful mechanism to identify areas ripe for quality improvement.",
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T1 - A new frontier for quality of care in gynecologic oncology surgery

T2 - Multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model

AU - Aletti, Giovanni D.

AU - Santillan, Antonio

AU - Eisenhauer, Eric L.

AU - Hu, Jae

AU - Aletti, Giacomo

AU - Podratz, Karl C.

AU - Bristow, Robert E.

AU - Chi, Dennis S.

AU - Cliby, William Arthur

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N2 - Objective: To test the feasibility and utility of a risk-adjusted, multicenter outcomes model for ovarian cancer surgery as a tool for quality improvement. Methods: Patient characteristics, intra-operative findings, procedures, and outcomes were assessed in primary advanced stage ovarian cancer cases from 3 independent centers. A surgical complexity score (SCS) was developed to adjust for extent of surgery. Outcomes measures were: 30-day morbidity (sepsis, thrombo-embolic, cardiac, readmission or re-operation), 3-month mortality, length of stay (LOS), and ability to receive chemotherapy. A multivariable risk-adjusted model was developed for all the outcomes. Observed-to-expected (O/E) outcome ratios were calculated from all data. Results: 564 consecutive patients from 3 centers were analyzed. The strongest predictors of 30-day morbidity were endogenous [albumin (p < 0.001) and ASA (p = 0.008)] and complexity of surgery [SCS (p < 0.001)]. Age (p = 0.002) and ASA (p = 0.001) independently predicted mortality. LOS independently correlated with age (p = 0.007), albumin (p = 0.004), SCS (p = 0.002), and stage (p = 0.024). ASA (p < 0.001) and SCS (p = 0.003) both impacted ability to receive chemotherapy. Observed to expected (O/E) ratios for dependent outcome variables were similar for all 3 institutions. Conclusions: We demonstrate the benefits of a national system for studying outcomes in gynecologic surgery using a risk-adjusted model. We specifically find that endogenous patient factors and complexity of surgery are primary drivers of morbidity in ovarian cancer surgery. These data can successfully be used to formulate expected, risk-adjusted rates of complications thus providing a meaningful mechanism to identify areas ripe for quality improvement.

AB - Objective: To test the feasibility and utility of a risk-adjusted, multicenter outcomes model for ovarian cancer surgery as a tool for quality improvement. Methods: Patient characteristics, intra-operative findings, procedures, and outcomes were assessed in primary advanced stage ovarian cancer cases from 3 independent centers. A surgical complexity score (SCS) was developed to adjust for extent of surgery. Outcomes measures were: 30-day morbidity (sepsis, thrombo-embolic, cardiac, readmission or re-operation), 3-month mortality, length of stay (LOS), and ability to receive chemotherapy. A multivariable risk-adjusted model was developed for all the outcomes. Observed-to-expected (O/E) outcome ratios were calculated from all data. Results: 564 consecutive patients from 3 centers were analyzed. The strongest predictors of 30-day morbidity were endogenous [albumin (p < 0.001) and ASA (p = 0.008)] and complexity of surgery [SCS (p < 0.001)]. Age (p = 0.002) and ASA (p = 0.001) independently predicted mortality. LOS independently correlated with age (p = 0.007), albumin (p = 0.004), SCS (p = 0.002), and stage (p = 0.024). ASA (p < 0.001) and SCS (p = 0.003) both impacted ability to receive chemotherapy. Observed to expected (O/E) ratios for dependent outcome variables were similar for all 3 institutions. Conclusions: We demonstrate the benefits of a national system for studying outcomes in gynecologic surgery using a risk-adjusted model. We specifically find that endogenous patient factors and complexity of surgery are primary drivers of morbidity in ovarian cancer surgery. These data can successfully be used to formulate expected, risk-adjusted rates of complications thus providing a meaningful mechanism to identify areas ripe for quality improvement.

KW - Morbidity

KW - Mortality

KW - Outcomes

KW - Quality of care

KW - Risk adjustment model

KW - Surgery

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