The following is a summary of “Textbook outcome as a composite outcome measure to compare hospital performances regarding cytoreductive surgery for ovarian cancer: A nationwide population-based study” early-stage cervical cancer: A propensity-score based analysis,” published in the July 2023 issue of Gynecologic Oncology by M.D. et al.

Textbook outcome (TO) is a composite outcome measure employed in surgical oncology for comparing hospital outcomes based on multiple quality indicators. This study sought to develop TO to measure healthcare quality for ovarian cancer patients undergoing cytoreductive surgery (CRS) at advanced stages. This population-based analysis included all CRS for FIGO IIIC-IVB primary ovarian cancer in the Netherlands between 2017 and 2020. The primary outcome was TO, defined as the absence of 30-day mortality, severe complications, and protracted length of hospitalization (>10 days). 

Due to the lack of data, delayed initiation of adjuvant chemotherapy (6 weeks) was not included in TO. The association between case-mix factors and TO was determined using logistic regressions. Using funnel plots, hospital variation was depicted. A total of 1909 CRS were included, of which 1434 were interval CRS and 475 were primary CRS. 54% of the break CRS cohort and 47% of the primary CRS cohort attained TO. The absence of TO was primarily due to macroscopic residual disease after CRS. In multivariable logistic regressions, age ≥ 70 was associated with reduced TO rates. In the interval CRS cohort, hospital-specific TO rates ranged from 40% to 69%, and in the primary CRS cohort, 22% to 100%. 

In both analyses, one hospital (different hospitals) had significantly reduced TO rates. Case-mix adjustment greatly impacted TO rates in the CRS’s primary research. TO is an appropriate composite outcome measure to detect hospital variation in healthcare quality for patients undergoing CRS with advanced-stage ovarian cancer. Adjustment for case-mix enhances the precision of hospital comparisons.

Source: sciencedirect.com/science/article/pii/S0090825823002007