Developing a risk stratification tool for audit of outcome after surgery for head and neck squamous cell carcinoma

作者：Tighe David F^*; Thomas Alan J; Sassoon Isabel; Kinsman Robin; McGurk Mark

来源：Head and Neck-Journal for the Sciences and Specialties of the Head and Neck, 2017, 39(7): 1357-1363.

DOI：10.1002/hed.24769

• audit
• complications
• head and neck
• outcomes
• squamous cell carcinoma

BackgroundPatients treated surgically for head and neck squamous cell carcinoma (HNSCC) represent a heterogeneous group. Adjusting for patient case mix and complexity of surgery is essential if reporting outcomes represent surgical performance and quality of care.
MethodsA case note audit totaling 1075 patients receiving 1218 operations done for HNSCC in 4 cancer networks was completed. Logistic regression, decision tree analysis, an artificial neural network, and Naive Bayes Classifier were used to adjust for patient case-mix using pertinent preoperative variables.
ResultsThirty-day complication rates varied widely (34%-51%; P < .015) between units. The predictive models allowed risk stratification. The artificial neural network demonstrated the best predictive performance (area under the curve [AUC] 0.85).
ConclusionEarly postoperative complications are a measurable outcome that can be used to benchmark surgical performance and quality of care. Surgical outcome reporting in national clinical audits should be taking account of the patient case mix.

• 出版日期2017-7