QS108 - A Decade of Rectal Cancer Quality Improvement: Impact of Regional Data Reporting and Feedback on Rectal Cancer Surgery Quality Metrics

Purpose/Background: Background: Rectal cancer remains prevalent, and contemporary management of rectal cancer has becoming increasingly complex. Several national initiatives have proposed measures of high-quality rectal cancer care with the goal of reducing variation and improving surgical outcomes. However, there continues to be significant variation in achievement of these quality measures that span the pre- and peri-operative periods. We hypothesized that systematic and individualized feedback of rectal cancer quality care performance would lead to continual improvement across several pre- and peri-operative metrics.

Methods/Interventions:

Methods: All elective rectal cancer resections performed at institutions that participated in the Surgical Care Outcomes Assessment Program (SCOAP) for every year between 2011 and 2022 were included for analysis. Six process measures were evaluated including preoperative MRI for staging (MRI), determination of tumor location in relation to the anal verge (TL), use of neoadjuvant chemoradiation (NAC), completion of a total mesorectal excision (TME), 12+ lymph nodes resected (LN), and negative distal and circumferential margins (NM). SCOAP sites and surgeons receive quarterly reports across all SCOAP metrics. Beyond this, SCOAP provided a targeted, detailed report on these rectal cancer measures at the end of 2015 and again at the end of 2019 to participating sites and surgeons. The feedback included individual and hospital level performance and benchmarking, and was reviewed at the annual SCOAP meeting. We used these feedback interventions to divide the cohort into three time periods, 2011-2016, 2017-2019, and 2020-2022, in order to determine the effect of feedback intervention on rectal cancer measures. In addition to individual measures, a composite score of all measures for each rectal cancer resection was also determined (possible score ranging from 0 to 6).

Results/Outcomes:

Results: Across 19 hospitals, 1,962 resections (mean age 61 years, 40% female) were performed (n=929, 47%, from 2011-2016; n=639, 33%, from 2017-2019; and n=394, 20%, from 2020-2022). There were statistically significant increases in MRI (2011-2016=32%, 2017-2019=88%, 2020-2022=92%; p< 0.01), TME (47%, 68%, 80%; p< 0.01), and LN (76%, 86%, 86%; p< 0.01) after one or both feedback sessions. TL (67%, 69%, 70%; p=0.558), NAC (62%, 63%, 67%; p=0.124), and NM (98%, 97%, 96%; p=0.39) had either marginal or no improvement in the rate of completion. The mean composite score for cases during each time period increased after each feedback (2011-2016=3.8+/-1.4; 2017-2019=4.3+/-1.4; 2020-2022=4.5+/-1.5; p< 0.01) (Figure 1).The proportion of cases for which 5 or more measures were achieved increased as well (2011-2016=33%, 2017-2019=52%, 2020-2022=60%; p< 0.01).

Conclusion/Discussion:

Conclusion: Feedback and benchmarking on rectal cancer quality process measures was associated with increased use of preoperative MRI, performance of TME, harvest of 12+ LNs, and overall number of measures achieved per case. Understanding the sustainability of this increase or whether repeat feedback interventions can result in further progress will be important to continue to advance the quality of rectal cancer surgical care.