Abstract Background Benchmark comparisons in surgery allow identification of gaps in the quality of care provided. The aim of this study was to determine quality thresholds for high (HAR) and low (LAR) anterior resections in colorectal cancer surgery by applying the concept of benchmarking. Methods This 5-year multinational retrospective study included patients who underwent anterior resection for cancer in 19 high-volume centres on five continents. Benchmarks were defined for 11 relevant postoperative variables at discharge, 3 months, and 6 months (for LAR). Benchmarks were calculated for two separate cohorts: patients without (ideal) and those with (non-ideal) outcome-relevant co-morbidities. Benchmark cut-offs were defined as the 75th percentile of each centre’s median value. Results A total of 3903 patients who underwent HAR and 3726 who had LAR for cancer were analysed. After 3 months’ follow-up, the mortality benchmark in HAR for ideal and non-ideal patients was 0.0 versus 3.0 per cent, and in LAR it was 0.0 versus 2.2 per cent. Benchmark results for anastomotic leakage were 5.0 versus 6.9 per cent for HAR, and 13.6 versus 11.8 per cent for LAR. The overall morbidity benchmark in HAR was a Comprehensive Complication Index (CCI®) score of 8.6 versus 14.7, and that for LAR was CCI® score 11.9 versus 18.3. Conclusion Regular comparison of individual-surgeon or -unit outcome data against benchmark thresholds may identify gaps in care quality that can improve patient outcome.

中文翻译：

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结直肠手术基准：确定高位和低位前切除质量阈值的多国研究

摘要 背景手术基准比较可以识别所提供护理质量的差距。本研究的目的是通过应用基准测试的概念来确定结直肠癌手术中高前切除术 (HAR) 和低前切除术 (LAR) 的质量阈值。 方法这项为期 5 年的跨国回顾性研究纳入了在五大洲 19 个大容量中心接受前路癌症切除术的患者。为出院时、3 个月和 6 个月（对于 LAR）时的 11 个相关术后变量定义了基准。为两个单独的队列计算基准：没有（理想）和有（非理想）结果相关合并症的患者。基准截止值定义为每个中心中值的第 75 个百分位。 结果总共分析了 3903 名因癌症接受 HAR 的患者和 3726 名因癌症接受 LAR 的患者。经过 3 个月的随访，HAR 中理想和非理想患者的死亡率基准分别为 0.0% 和 3.0%，LAR 中的死亡率基准分别为 0.0% 和 2.2%。HAR 吻合口瘘的基准结果为 5.0%，LAR 为 13.6%，LAR 为 11.8%，HAR 为 6.9%。HAR 的总体发病率基准是综合并发症指数 (CCI®) 评分为 8.6 比 14.7，LAR 的 CCI® 评分为 11.9 比 18.3。 结论定期将个体外科医生或单位的结果数据与基准阈值进行比较，可以发现护理质量方面的差距，从而改善患者的治疗结果。