Predictive Value of KLASS-02-QC Assessment Score on KLASS-02 Surgical Outcomes

Author:

Song Jeong Ho12,Shin Hye Jung3,Hyung Woo Jin1,Yang Han-Kwang4,Han Sang-Uk2,Park Young-Kyu5,Lee Hyuk-Joon4,An Ji Yeong6,Kim Wook7ORCID,Kim Hyung-Ho8,Ryu Seung Wan9,Hur Hoon2,Kim Min-Chan10,Kong Seong-Ho4,Kim Jin-Jo11,Park Do Joong4,Kim Young Woo12,Ryu Keun Won12,Kim Jong Won13,Lee Joo-Ho14,Kim Hyoung-Il1

Affiliation:

1. Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea

2. Department of Surgery, Ajou University School of Medicine, Suwon, South Korea

3. Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea

4. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea

5. Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea

6. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

7. Department of Surgery, Yeouido St Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea

8. Department of Surgery, Seoul National University Bundang Hospital, Seoul, South Korea

9. Keimyung University Dongsan Medical Center, Daegu, South Korea

10. Department of Surgery, Dong-A University Hospital, Busan, South Korea

11. Department of Surgery, Incheon St Mary’s Hospital, The Catholic University of Korea, Incheon, South Korea

12. Center for Gastric Cancer, National Cancer Center, Goyang, Korea

13. Department of Surgery, Chung-Ang University Hospital, Seoul, South Korea

14. Department of Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea

Abstract

Objective: The aim of this study was to audit the 22 items and assessed each item's predictive value on surgical outcomes. Background: The KLASS-02 trial revealed that the oncologic outcomes of laparoscopic distal gastrectomy are not inferior to open distal gastrectomy in patients with advanced gastric cancer. The surgeons participating in this trial were chosen based on the assessment scores from the KLASS-02-QC trial, which used 22 items for standardization of D2 lymphadenectomy and quality control. Methods: We reviewed proficiency scores (PSs) for 22 items for 20 surgeons who participated in KLASS-02. The surgeons were divided into 2 groups according to PS, and the perioperative outcomes of 924 patients enrolled in KLASS-02 were compared between groups. Each item's predictive value for perioperative outcome was then assessed using multivariable regression models. Results: Of the total 924 patients, 529 were operated on by high-score surgeons (high PS) and 395 were operated on by low-score surgeons (low-PS). High-PS group had less intraoperative blood loss, longer operation times, and fewer complications, major complications, reoperations, and shorter first flatus and hospital stay than low-PS group (P=0.006, P<0.001, P<0.001, P<0.001, P=0.042, P=0.013, and P<0.001, respectively). Some items used in KLASS-02-QC predicted perioperative outcomes, such as intraoperative blood loss, major complications, reoperation, and hospital stay. Conclusions: Although this study only analyzed data associated with qualified surgeons, the 22 items effectively assessed the surgeons based on PS. A high score was associated with longer operation times, but better perioperative outcomes.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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