Download The Royal Marsden NHS Foundation Trust []

National Bowel Cancer Report 2015
This report is compiled by the National Bowel Cancer Audit to allow the review of process and outcome
measures at the trust and network level. The annual report and FAQs are available at
www.hscic.gov.uk/bowel.
Data from this report is on patients in England and Wales diagnosed with bowel cancer 1 Apr 2013 –
31 Mar 2014 unless otherwise stated. The Audit dataset is linked to Hospital Episode Statistics (HES)
at the patient level to obtain further information on patient care and follow-up such as stoma reversal
and emergency readmissions in England.
1. Data Quality
Data completeness: per cent of relevant patient group with useable value of data item.
Case ascertainment: number of patients reported to the Audit as a percentage of the number of
patients admitted for the first time to the trust/network with a diagnosis of bowel cancer within the
audit period according to HES. This can be larger than 100 if more patients are reported to the
Audit than identified in HES.
Seven audit items for risk-adjustment: the per cent of patients with complete data items on all of
age, sex, ASA grade, pathological T-stage, pathological N-stage, distant metastases and site of
cancer.
2. & 3. Management of patients
No major resection: too little cancer: those undergoing a local resection or polypectomy.
No major resection: too much cancer: no excision and reason for no treatment includes
advanced stage cancer OR no excision and non-curative intent and metastatic disease.
No major resection: too frail: [not in too much cancer group] AND [no excision and reason for no
treatment includes significant co-morbidity OR no excision and performance status 3 or 4].
No major resection: unknown/other reason: no excision and does not meet any of the above
criteria.
4. & 5. Outcomes of patients having major resection and rectal cancer patients
Cross-sections of funnel plots display trust and network observed and risk-adjusted outcomes for 90day mortality, 90-day unplanned readmission, 2-year mortality and, for rectal cancer patients, 18-month
stoma rate. The colours represent the regions defined by the 95 per cent limit and the 99.8 per cent limit
for trusts and networks compared to the national average (vertical line). Those networks or trusts with
results outside the outer (99.8 per cent) limit are considered potential outliers.
Risk adjustment is performed using the seven items listed in section 1 as well as mode of admission
(elective/emergency) and number of co-morbidities according to HES¹, and an interaction between age
and distant metastases². Missing values are imputed using Multiple Imputation³ . The model for twoyear mortality additionally included interactions between follow-up time (0-3 months after surgery vs. 324 months after surgery) and all of the risk factors. See FAQs for more details.
A stoma is considered to be reversed if a HES record with relevant code is identified with 18 months of
the initial surgical procedure.
[1] British Journal of Surgery 2010; 97: 772–781
[2] British Journal of Surgery 2015; 102: 269–280
[3] Statistics in Medicine 2011; 30: 377–399
1
Trust: The Royal Marsden NHS Foundation Trust
Network: London Cancer Alliance
1. Data Quality
All Patients :
Trust
Network
National
Trust denominator
*
N patients in Audit
*
1,947
30,663
Case ascertainment %
*
77
94
Key:
< 60%
60 - 80%
>= 80%
Data completeness of:
Pre-treatment TNM %
*
89
84
Performance status %
*
79
68
* Case Ascertainment and Treatment Pathway are not presented for this Trust as it is a tertiary cancer centre.
Patients having major resection:
Trust
Network
National
Trust denominator
48
ASA grade 1 %
4
20
12
ASA grade 2 %
69
49
54
ASA grade 3 %
27
21
26
ASA grade 4+ %
0
2
3
ASA grade not recorded %
0
9
6
94
82
80
Data completeness of:
7 Audit items for risk-adjustment %
2. Management of all patients
All patients:
Trust
Network
National
Trust denominator
*
Seen by Clinical Nurse Specialist %
*
90
93
Major resection %
*
67
63
No major resection: too little cancer %
*
3
4
*
16
15
*
15
17
Trust
Network
National
Treatment pathway:
No major resection: too much cancer or too
frail %
No major resection: unknown/other reason %
3. Management of patients having major resection
Patients having major resection:
Trust denominator
48
Distant metastases %
9
10
10
Urgent or emergency surgery %
6
14
16
Median number of lymph nodes excised
17
18
17
Laparoscopic surgery attempted %
40
57
57
Length of stay > 5 days %
100
73
69
2
4. Outcomes of patients having major resection
90-day mortality %
Key:
J > 99.8% limit
J > 95% limit
J within limits
J < 95% limit
J < 99.8% limit
90-day unplanned readmission %
Observed
Adjusted
2-year mortality %:
Patients diagnosed 1 Apr 2011 - 31 Mar 2012
5. Rectal cancer patients
Patients having major resection:
Trust
Network
National
Trust Denominator
26
Neoadjuvant therapy %
88
41
39
Circumferential resection margin: Positive %
0
9
5
Circumferential resection margin: Missing %
8
12
26
APER rate %
27
19
26
18-month stoma rate %:
Key:
Patients having surgery 1 Apr 2010 - 31 Mar 2013
J > 99.8% limit
J > 95% limit
J within limits
J < 95% limit
J < 99.8% limit
Observed
Adjusted
3