• Roxane D Staiger, Fabian Rössler, Min Jung Kim, Carl Brown, Loris Trenti, Takeshi Sasaki, Deniz Uluk, Juan P Campana, Massimo Giacca, Boris Schiltz, Renu R Bahadoer, Kai-Yin Lee, Bruna E C Kupper, Katherine Y Hu, Francesco Corcione, Steven R Paredes, Sebastiano Spampati, Kristjan Ukegjini, Bartlomiej Jedrzejczak, Daniel Langer, Aine Stakelum, Ji Won Park, P Terry Phang, Sebastiano Biondo, Masaaki Ito, Felix Aigner, Carlos A Vaccaro, Yves Panis, Alex Kartheuser, PeetersK C M JKCMJDepartment of Surgery, Leiden University Medical Centre, Leiden, the Netherlands., Ker-Kan Tan, Samuel Aguiar, Kirk Ludwig, Umberto Bracale, Christopher J Young, Adam Dziki, Miroslav Ryska, Des C Winter, John T Jenkins, Robin H Kennedy, Pierre-Alain Clavien, Milo A Puhan, and Matthias Turina.
• Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland.
• Br J Surg. 2022 Nov 22; 109 (12): 127412811274-1281.

BackgroundBenchmark 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.MethodsThis 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.ResultsA 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.ConclusionRegular comparison of individual-surgeon or -unit outcome data against benchmark thresholds may identify gaps in care quality that can improve patient outcome.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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