BACKGROUND: Benchmark comparisons in surgery allow identification of gaps in the quality of care provided. The aim of this study was to determine quality thresholds for high (HAR) and low (LAR) anterior resections in colorectal cancer surgery by applying the concept of benchmarking. METHODS: This 5-year multinational retrospective study included patients who underwent anterior resection for cancer in 19 high-volume centres on five continents. Benchmarks were defined for 11 relevant postoperative variables at discharge, 3 months, and 6 months (for LAR). Benchmarks were calculated for two separate cohorts: patients without (ideal) and those with (non-ideal) outcome-relevant co-morbidities. Benchmark cut-offs were defined as the 75th percentile of each centre's median value. RESULTS: A total of 3903 patients who underwent HAR and 3726 who had LAR for cancer were analysed. After 3 months' follow-up, the mortality benchmark in HAR for ideal and non-ideal patients was 0.0 versus 3.0 per cent, and in LAR it was 0.0 versus 2.2 per cent. Benchmark results for anastomotic leakage were 5.0 versus 6.9 per cent for HAR, and 13.6 versus 11.8 per cent for LAR. The overall morbidity benchmark in HAR was a Comprehensive Complication Index (CCI®) score of 8.6 versus 14.7, and that for LAR was CCI® score 11.9 versus 18.3. CONCLUSION: Regular comparison of individual-surgeon or -unit outcome data against benchmark thresholds may identify gaps in care quality that can improve patient outcome.

A C Camargo Cancer Centre São Paulo Brazil

Bellvitge University Hospital Department of General and Digestive Surgery and IDIBELL University of Barcelona Barcelona Spain

Centre for Bowel Diseases Brzeziny Poland

Centre for Colorectal Disease St Vincent's University Hospital Dublin Ireland

Department of Colorectal Surgery and Surgical Technology National Cancer Centre Hospital East Kashiwa Chiba Japan

Department of Colorectal Surgery Beaujon Hospital and University of Paris Clichy France

Department of Colorectal Surgery Cliniques Universitaires St Luc UCL Brussels Belgium

Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia

Department of Colorectal Surgery St Mark's Hospital London UK

Department of Colorectal Surgery University Hospital Zurich Zurich Switzerland

Department of Epidemiology Epidemiology Biostatistics and Prevention Institute University of Zurich Zurich Switzerland

Department of General and Colorectal Surgery Medical University Lodz Poland

Department of General Surgery and Specialty University Federico 2 of Naples Naples Italy

Department of Surgery Campus Charité Mitte and Campus Virchow Klinikum Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin Berlin Germany

Department of Surgery Leiden University Medical Centre Leiden the Netherlands

Department of Surgery Seoul National University College of Medicine Seoul Korea

Department of Surgery University of British Columbia St Paul's Hospital Vancouver British Columbia Canada

Department of Surgery Yong Loo Lin School of Medicine National University of Singapore University Surgical Cluster National University Health System Singapore

Division of Colorectal Surgery Department of Surgery Medical College of Wisconsin Milwaukee WI USA

Section of Colorectal Surgery Hospital Italiano de Buenos Aires and Instituto de Medicina Traslacional e Ingeniería Biomédica Buenos Aires Argentina

Surgery Department Charles University and Central Military Hospital Prague Czech Republic

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