Early outcomes from the Dutch Upper Gastrointestinal Cancer Audit

BackgroundIn 2011, the Dutch Upper Gastrointestinal Cancer Audit (DUCA) group began nationwide registration of all patients undergoing surgery with the intention of resection for oesophageal or gastric cancer. The aim of this study was to describe the initiation and implementation of this process along with an overview of the results. MethodsThe DUCA is part of the Dutch Institute for Clinical Auditing. The audit provides (surgical) teams with reliable, weekly updated, benchmarked information on process and (case mix-adjusted) outcome measures. To accomplish this, a web-based registration was designed, based on a set of predefined quality measures. ResultsBetween 2011 and 2014, a total of 2786 patients with oesophageal cancer and 1887 with gastric cancer were registered. Case ascertainment approached 100 per cent for patients registered in 2013. The percentage of patients with oesophageal cancer starting treatment within 5 weeks of diagnosis increased significantly over time from 325 per cent in 2011 to 410 per cent in 2014 (P < 0001). The percentage of patients with a minimum of 15 examined lymph nodes in the resected specimen also increased significantly for both oesophageal cancer (from 503 per cent in 2011 to 730 per cent in 2014; P < 0001) and gastric cancer (from 475 per cent in 2011 to 736 per cent in 2014; P < 0001). Postoperative mortality remained stable (around 40 per cent) for patients with oesophageal cancer, and decreased for patients with gastric cancer (from 80 per cent in 2011 to 40 per cent in 2014; P = 0031). ConclusionNationwide implementation of the DUCA has been successful. The results indicate a positive trend for various process and outcome measures.