Esophagectomy Quality Measures

Quality measures, also referred to as quality indicators, can be used to report how well an organization provides care for patients undergoing certain procedures and/or for patients with particular medical conditions. They assess aspects of healthcare structure (such as types and availability of services), outcomes (such as infection rates, mortality, length of stay), or processes (such as giving antibiotics prior to and after certain surgical procedures).

Research was conducted to determine the established or emerging quality measures for esophagectomy, a surgical procedure performed to take out part or all of the esophagus because it has cancerous growth. These quality statements provide relevant information needed to help you make more informed decisions about your healthcare.

Quality measures have been provided for each of the topics below. In addition, you will find information about the sources used to establish each quality measure. This information is provided to help you assess the ability of our organization to provide quality health care for you and/or your family members.

Annual surgical volume for esophagectomy procedures

The Leapfrog Group suggested that a hospital that performs 13 esophagectomy procedures per year has better outcomes. Several study results demonstrate improved outcomes in hospitals that perform a large number of esophagectomies. (Journal of Thoracic and Cardiovascular Surgery, June 2000: 119(6); 1126-1134)

Robert Wood Johnson University Hospital performed 17 esophagectomy procedures in 2004, exceeding the Leapfrog Group's recommended volume of 13 procedures per year.

Physician board certification

A board-certified physician has completed an approved educational training program and an evaluation process including an examination designed to assess the knowledge, skills, and experience necessary to provide quality patient care in that specialty. A specialty certificate is issued by a medical specialty certifying board, which is valid nationwide. Although certification is not required for an individual physician to practice medicine, most hospitals and managed care organizations require that at least a certain percentage of their staff be "board certified." Today, approximately 89% of licensed physicians are certified by one or more ABMS Member Boards. (American Board of Medical Specialties)

All of Robert Wood Johnson University Hospital's thoracic surgeons who perform esophagectomy are board certified in Thoracic Surgery by the American Board of Thoracic Surgery.

Average length of stay for esophagectomy

According to the most recent national data from the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), the average post-procedure length of stay for esophagectomy procedures was 16.2 days.

Robert Wood Johnson University Hospital's average length of stay for esophagectomy surgery was 16.3 days in 2004.

Availability of advanced techniques/interventions for esophagectomy

Since 1988, improvements in techniques, practices, and processes, such as transhiatal (the incision is made through the neck) and transthoracic (the incision is made across or through the thoracic cavity or chest wall) surgical approaches, and improved anesthetic medications, have also contributed to improved outcomes for persons having esophageal surgery. The various surgical approaches differ in location of the incisions and in the methods used to remove part or all of the esophagus. The surgical approach is often determined by the tumor location. (Annals of Surgery, August 2000: 232(2); 225-232)

Another study reports that the minimally invasive approach or thoracoscopic technique is also a viable option for some patients. (Annals of Surgery, October 2003: 238(4); 486-495)

Robert Wood Johnson University Hospital has advanced techniques and interventions available for the surgical treatment of esophageal cancer including:

Antibiotic prophylaxis

According to JCAHO's Surgical Infection Prevention Core Performance Measures, patients undergoing surgery should receive a prophylactic antibiotic within one hour prior to the surgical incision being made.

91% of Robert Wood Johnson University Hospital's esophagectomy patients received prophylactic antibiotics within one hour prior to the surgical incision in 2004-2005.

In 2004, two patients received their prophylactic antibiotic 15 minutes and 20 minutes early, which yielded an 88% performace. Neither patient developed post-operative infection. However, process improvements resulted in a 100% performance in 2005. Our team of surgeons, anesthesiologists and nurses now utilize computerized antibiotic screens and intraoperative reminders to ensure antibiotics are given within one hour before a surgical incision is made.

Postoperative high-density barium swallow

A barium swallow is an x-ray examination of the upper gastrointestinal (GI) tract, specifically the pharynx (back of mouth and throat) and the esophagus (hollow tube of muscle extending from below the tongue to the stomach). The pharynx and esophagus are made visible on x-ray film by a liquid suspension called barium. A barium swallow may be performed separately or as part of an upper gastrointestinal (UGI) series, which evaluates the esophagus, stomach, and duodenum (first part of the small intestine).

Because a postoperative leak around the sutures is a serious complication that may occur after esophagectomy, a barium swallow is generally performed before allowing an esophagectomy patient to resume taking food and liquids by mouth.

According to the American Journal of Roentgenology, studies support the use of high-density barium as part of the routine postoperative radiographic examination to rule out leakage before beginning oral feedings or if a leak is suspected. A water-soluble contrast agent should not be used. (American Journal of Roentgenology, August 2003: 181(2); 415-420)

In 2004-2005, 100% of transhiatal esophagectomy patients at Robert Wood Johnson University Hospital received routine postoperative high-density barium swallows.

Inpatient mortality rate for esophagectomy

According to the most recent data available from the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), the inpatient mortality rate for esophagectomy was 8.4%. (HCUP)

The inpatient mortality rate for esophagectomy at Robert Wood Johnson University Hospital was 0% in 2004-2005, which is better than the national average of 8.4%.

 

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