TY - JOUR
T1 - Case-mix adjustment for between-hospital comparisons in oesophageal and gastric cancer surgery
AU - van der Linde, Margrietha
AU - Visser, Maurits R.
AU - Eijkenaar, Frank
AU - Oude Voshaar, Martijn A.H.
AU - van Hillegersberg, Richard
AU - van Sandick, Johanna W.
AU - van Berge Henegouwen, Mark I.
AU - Wijnhoven, Bas P.L.
AU - Lingsma, Hester F.
AU - Dutch Upper Gastrointestinal Cancer Audit (DUCA)
N1 - Publisher Copyright: © 2025 The Authors
PY - 2025/6
Y1 - 2025/6
N2 - Background: Clinical and pathological outcomes of oesophagogastric cancer surgery are used for benchmarking hospital performance. The extent to which case-mix adjustment is required for valid hospital comparisons is unknown. This study aimed to develop distinct case-mix adjustment models for multiple outcomes of oesophageal and gastric cancer surgery, and to assess the impact of case-mix adjustment on between-hospital comparisons. Methods: We included all patients who underwent oesophagogastric cancer resections in the Netherlands between 2017 and 2022. We developed distinct case-mix adjustment models for ten outcomes. Model performance was evaluated with the area-under-the-receiving-operator-curve (AUC) and pseudo-R-squared, representing how strongly case-mix factors predict the outcomes. We used the Wald χ2 test to assess relative predictor importance per model. The impact of case-mix adjustment on between-hospital comparisons on outcome was quantified using unadjusted and adjusted observed/expected ratios. Results: In total, 4354 oesophageal cancer patients and 2109 gastric cancer patients were included. The most informative predictors in the models for oesophageal cancer were ASA-score, salvage surgery, peripheral vascular disease/aortic aneurysm, chronic lung disease, and tumour histology. For gastric cancer these were age, preoperative weight loss, tumour location, and clinical M-category. All case-mix models showed low to moderate performance, with AUCs ranging between 0.58 and 0.73 and between 0.58 and 0.74 for oesophageal and gastric cancer, respectively. Overall, case-mix adjustment had a limited impact on between-hospital comparisons, but more pronounced for 30-day mortality, failure-to-cure and failure-to-rescue. Conclusion: Given low to moderate model performance and the limited impact on between-hospital comparisons, case-mix adjustment may not always be necessary for valid benchmarking on outcomes in oesophagogastric cancer surgery.
AB - Background: Clinical and pathological outcomes of oesophagogastric cancer surgery are used for benchmarking hospital performance. The extent to which case-mix adjustment is required for valid hospital comparisons is unknown. This study aimed to develop distinct case-mix adjustment models for multiple outcomes of oesophageal and gastric cancer surgery, and to assess the impact of case-mix adjustment on between-hospital comparisons. Methods: We included all patients who underwent oesophagogastric cancer resections in the Netherlands between 2017 and 2022. We developed distinct case-mix adjustment models for ten outcomes. Model performance was evaluated with the area-under-the-receiving-operator-curve (AUC) and pseudo-R-squared, representing how strongly case-mix factors predict the outcomes. We used the Wald χ2 test to assess relative predictor importance per model. The impact of case-mix adjustment on between-hospital comparisons on outcome was quantified using unadjusted and adjusted observed/expected ratios. Results: In total, 4354 oesophageal cancer patients and 2109 gastric cancer patients were included. The most informative predictors in the models for oesophageal cancer were ASA-score, salvage surgery, peripheral vascular disease/aortic aneurysm, chronic lung disease, and tumour histology. For gastric cancer these were age, preoperative weight loss, tumour location, and clinical M-category. All case-mix models showed low to moderate performance, with AUCs ranging between 0.58 and 0.73 and between 0.58 and 0.74 for oesophageal and gastric cancer, respectively. Overall, case-mix adjustment had a limited impact on between-hospital comparisons, but more pronounced for 30-day mortality, failure-to-cure and failure-to-rescue. Conclusion: Given low to moderate model performance and the limited impact on between-hospital comparisons, case-mix adjustment may not always be necessary for valid benchmarking on outcomes in oesophagogastric cancer surgery.
UR - http://www.scopus.com/inward/record.url?scp=85218905025&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2025.109644
DO - 10.1016/j.ejso.2025.109644
M3 - Article
C2 - 40014956
AN - SCOPUS:85218905025
SN - 0748-7983
VL - 51
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 6
M1 - 109644
ER -
