Value of individual surgeon performance metrics as quality assurance measures in oesophagogastric cancer surgery.

Background Surgeon-level operative mortality is widely seen as a measure of quality after gastric and oesophageal resection. This study aimed to evaluate this alongside a compound-level outcome analysis. Methods Consecutive patients who underwent treatment including surgery delivered by a multidisciplinary team, which included seven specialist surgeons, were studied. The primary outcome was death within 30 days of surgery; secondary outcomes were anastomotic leak, Clavien-Dindo morbidity score, lymph node harvest, circumferential resection margin (CRM) status, disease-free (DFS), and overall (OS) survival. Results The median number of annual resections per surgeon was 10 (range 5-25), compared with 14 (5-25) for joint consultant teams (P = 0 center dot 855). The median annual surgeon-level mortality rate was 0 (0-9) per cent versus an overall network annual operative mortality rate of 1 center dot 8 (0-3 center dot 7) per cent. Joint consultant team procedures were associated with fewer operative deaths (0 center dot 5 per cent versus 3 center dot 4 per cent at surgeon level; P = 0 center dot 027). The median surgeon anastomotic leak rate was 12 center dot 4 (range 9-20) per cent (P = 0 center dot 625 versus the whole surgical range), overall morbidity 46 center dot 5 (31-60) per cent (P = 0 center dot 066), lymph node harvest 16 (9-29) (P < 0 center dot 001), CRM positivity 32 center dot 0 (16-46) per cent (P = 0 center dot 003), 5-year DFS rate 44 center dot 8 (29-60) per cent and OS rate 46 center dot 5 (35-53) per cent. No designated metrics were independently associated with DFS or OS in multivariable analysis. Conclusion Annual surgeon-level metrics demonstrated wide variations (fivefold), but these performance metrics were not associated with survival.