PERIOPERATIVE PROCESS AND OUTCOME INDICATORS FOR PANCREATIC DUCTAL ADENOCARCINOMA IN A TERTIARY CARE INSTITUTION: A DESCRIPTIVE STUDY

Abstract

Background: Pancreatic ductal adenocarcinoma is a deadly disease with variable treatment practices and quality of care between healthcare systems. Processes of care may be used to describe the quality of care provided to a population and may be used to target potential areas for quality improvement. The quality of care provided to resected pancreatic adenocarcinoma patients is poorly understood in Canada with respect to process-based indicators and is unknown in Nova Scotia.

Methods: This was a descriptive cross-sectional study of all patients diagnosed with PDAC who underwent resection in a single centre. Administrative and abstracted health data were linked to a review of the medical record to study the quality of care provided to resected PDAC patients. Established processes of care were reported as proportions with 95% confidence intervals and examined for changes between two time periods (2001-2005 vs 2006-2010). Acceptable performance was defined as greater than 90% of patients meeting a particular process of care indicator.

Results: During the study period, there were <100 patients who had resection for PDAC. The majority of these patients had advanced disease, with local invasion (T3/4: 81.9%) or positive lymph nodes (N1: 61.7%). With respect to the quality of care, there was variable performance upon published quality indicators. Most patients received timely preoperative imaging workup (93.6%) and timely care (82.0%). Within the perioperative and pathology domains, two indicators that showed poor performance were: the number of lymph nodes examined ≥10 (33.0%) and pancreatic uncinate process margin reporting (48.9%). These indicators did improve significantly over time. Although the proportion of patients who received adjuvant therapy or had a valid reason for not receiving adjuvant chemotherapy was much lower than the quality threshold (42.6%), this did improve over time (2001-2005: 26.7% versus 2006-2010: 57.1%; p<0.01). The 30- and 90-day mortality staying stable at 5.3%. The 2- and 5-year survival for patients with resected pancreatic adenocarcinoma in Nova Scotia was 29.3% (95% CI: 19.9-38.7%) and 9.4% (95% CI: 2.2-16.6%).

Conclusions: The quality of care provided to resected PDAC patients in Nova Scotia is relatively good with respect to performance on quality indicators over the study period. However, there may be potential for improvement in pathology reporting and medical oncology utilization in the future. The perioperative complications, perioperative mortality and survival are comparable to other populations with pancreatic cancer. It is unclear whether improving process of care indicators will affect long-term survival in resected PDAC patients.