Refining the thoracic surgical oncology regionalization standards for esophageal surgery in Ontario, Canada: Moving from good to better.

Autor:	Wright FC; Surgical Oncology Program, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada. Electronic address: Frances.wright@sunnybrook.ca., Milkovich J; Surgical Oncology Program, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada., Hunter A; Surgical Oncology Program, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada., Darling G; Surgical Oncology Program, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery/Surgical Oncology, Toronto General Hospital, Toronto, Ontario, Canada., Irish J; Surgical Oncology Program, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2023 Dec; Vol. 166 (6), pp. 1502-1509. Date of Electronic Publication: 2023 Mar 10.
DOI:	10.1016/j.jtcvs.2023.03.002
Abstrakt:	Background: The consolidation of surgical practices has been suggested to improve patient outcomes for complex surgeries. In 2005, Ontario Health-Cancer Care Ontario released the Thoracic Surgical Oncology Standards to facilitate the regionalization process at thoracic centers in Ontario, Canada. This work describes the quality-improvement process involved in updating the minimum surgical volume and supporting requirement recommendations for thoracic centers to further optimize patient care for esophageal cancer. Methods: We conducted a literature review to identify and synthesize evidence informing the volume-outcome relationship related to esophagectomy. The results of this review and esophageal cancer surgery common indicators (reoperation rate, unplanned visit rate, 30-day and 90-day mortality) from Ontario's Surgical Quality Indicator Report were presented and reviewed by a Thoracic Esophageal Standards Expert Panel and Surgical Oncology Program Leads at Ontario Health-Cancer Care Ontario. Hospital outliers were identified, and a subgroup analysis was conducted to determine the most appropriate minimum surgical volume threshold based on 30- and 90-day mortality rates data from the last 3 fiscal years. Results: Based on the finding that a significant decrease in mortality occurred at 12 to 15 esophagectomies per year, the Thoracic Esophageal Standards Expert Panel reached a consensus that thoracic centers should perform a minimum of 15 esophagectomies per year. The panel also recommended that any center performing esophagectomies have at least 3 thoracic surgeons to ensure continuity in clinical care. Conclusions: We have described the process involved in updating the provincial minimum volume threshold and the appropriate support services for esophageal cancer surgery in Ontario. (Copyright © 2023 The American Association for Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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