How to compare quality and safety of surgery for cancer?

We will discuss “Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study” by Burnell and co-workers from 27 April 2016 for 7 days.

*This paper is now online and FREE-TO-VIEW

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Start date: 27 April (the discussion will open for 7 days between 27 April to 4 May 2016)

First hosted discussion session(s) starts at: GMT+1 (British Summer Time) 8pm 

Host: @BlueJCHost

Platforms: Twitter, FacebookLinkedIn and Weibo

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published Journal Club guide)


A specialist gynaecological oncology centre reviewed complication rates of their patients who had undergone surgery in the last decade; they observed a gradual improvement over time. A trainee doctor asked, ‘how do specialist gynaecological oncology centres compare on these key quality and safety indicators?

Description of research

Participants Ten UK gynaecological oncology centres.
Intervention Prospective collection of surgery and morbidity data (both intraoperative and postoperative) on consented patients.
Comparison Crude and risk-adjusted intraoperative and postoperative complication rates between centres.
Outcomes Benchmarking using colour-coded funnel plots and observed-to-expected ratios.
Study design Risk-prediction modelling using penalised (lasso) logistic regression.
Authors’ conclusion Risk adjustment had a modest effect on the complication rates of the centres but helped to better delineate the outliers.

Discussion Points

  • How does your hospital collate and disseminate data on safety and quality indicators of surgery performed?
  • Which additional indicators could be collated routinely to help determine quality and safety of surgery (see suggested reading)?
  • What is benchmarking in healthcare? Why is it important?
  • What is the lasso method for penalised logistic regression?
  • Only half (1462/2948) of the procedures had follow-up data. How does this impact on the results in this study?
  • Refer to the funnel plots, how were the ‘warning bands’ determined? Are there alternative ways to identify outliers?
  • How can we improve quality and safety of surgery once outliers are identified?
  • How would the results of this study influence your daily practice?

Suggested reading

  • Iyer R, Gentry-Maharaj A, Nordin A, Burnell M, Liston R, Manchanda R, et al. Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications). Br J Cancer2015;112:475–84.
  • Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C, et al. ICBP Module 1 Working Group. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007: an analysis of population-based cancer registry data. Lancet2011;377(9760):127–38.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.