eP533 - Positive Margins for Colorectal Cancer Surgery: A Michigan Surgical Quality Collaborative Project

ePoster Presenter(s)

• 

  Brendan Rosamond (he/him/his)

  Medical Student
  University of Houston Tilman J. Fertitta Family College of Medicine
  University of Houston Tilman J. Fertitta Family College of Medicine
  Fulshear, TX, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• SS

  Sara Schaefer, MD

  Surgery Resident
  University of Michigan
  Ann Arbor, Michigan, United States

  Disclosure information not submitted.
• CR

  Cheryl Rocker, MSN, RN

  Education Specialist
  Michigan Surgical Quality Collaborative
  Ann Arbor, Michigan, United States

  Disclosure information not submitted.
• SB

  Sarah Bradley, PhD

  Statistician Lead
  University of Michigan
  Ann Arbor, Michigan, United States

  Disclosure information not submitted.
• 

  Gifty Kwakye, MD, MPH

  Arthur W Fleming M.D. Research Professor and Associate Professor of Surgery
  University of Michigan
  University of Michigan
  Ann Arbor, Michigan, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  Samantha Hendren, MD, MPH (she/her/hers)

  Associate Professor
  University of Michigan
  University of Michigan
  Ann Arbor, Michigan, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• CH

  Calista Harbaugh, MD, MSc

  Assistant Professor of Surgery
  University of Michigan
  Ann Arbor, Michigan, United States

  Disclosure information not submitted.

Purpose/Background: Positive margins after colorectal cancer (CRC) operations suggest incomplete cancer resection and are associated with poor oncologic outcomes. The Michigan Surgical Quality Collaborative (MSQC) is a 69-hospital consortium that collects robust clinical data and motivates quality improvement (QI) through financial incentives in partnership with Blue Cross Blue Shield of Michigan (BCBSM). Prior work demonstrated significant variation in positive margin rates across MSQC hospitals. This study describes a 2022 pay-for-performance project in the MSQC that focused on positive margins using data audit and multidisciplinary case review.Methods/Interventions: This was a retrospective study of quantitative and qualitative data gathered from 8 voluntarily participating hospitals. Qualitative data was extracted from written reports of each multidisciplinary case review of any cases resulting in a positive margin. Written data was reviewed by two study team members using a combined approach of inductive and deductive analysis to identify codes and aggregate them into themes.Results/Outcomes: Eight hospitals participated in the project. At baseline, individual hospitals’ positive margin rates ranged from 0% to 11.5% and at the end of the project, the range was 0% to 4.9%. For positive margin cases, 11 multidisciplinary case reviews were reported by hospitals. Potential root causes for positive margins were analyzed through qualitative analysis of hospitals’ case discussions (Figure 1). Themes included preoperative imaging failures; surgeon attitudes about management of urgent cases, acceptable morbidity, and resectability; and disagreement between surgeons and pathologists. Multiple cases were described as “unavoidable”.Conclusion/

Discussion: A multi-hospital quality improvement project for colorectal cancer surgery gives insight into the problem of positive margins. Themes in qualitative analysis of hospitals’ discussions of these cases included preoperative imaging failures, surgeon attitudes about management of urgent cases, acceptable morbidity and resectability, and disagreement between surgeons and pathologists. The finding that positive margins were deemed “unavoidable” in case discussions provides a target for quality improvement through education.Themes Surrounding Positive Margins After Colorectal Cancer Operations Identified by Multidisciplinary Review