HPB (AUGIS HPB Cancer Resection database)
Reports of on-going HPB Audits
HPB cancer resection audit
The AUGIS HPB cancer resection database was launched at the AUGIS meeting in Nottingham in September 2009. To date over 950 cancer resections have been entered and an annual update was presented at the 2010 Annual meeting in Oxford. The presentation, given by Mr Iain Cameron, highlighted the excellent patient recruitment to date, confirmed the generous support of MerckSerono who have agreed to sponsor the database for the next 3 years and detailed future plans for the database.
Alongside the Cancer resection audit runs the Ablation audit supported by an educational grant from Acculis:
http://mta.emdt.net:8080/emdt/login.jsp
Access to the AUGIS HPB cancer resection database and the Ablation database is obtained by logging in and using your password. If you do not have login details or a password then please contact Ardeo on lad@ardeo.com or telephone: 0870 909 4100. Alternatively contact me at david.berry@wales.nhs.uk.
A major reason cited for the failure of individuals or units to enter data into the AUGIS HPB cancer resection database has been the need for dual data entry where an in-house database exists. I can report that AUGIS and Ardeo are in the final stages of discussions regarding direct electronic transfer of data from existing databases. Establishing electronic links is expensive but funds should be available to facilitate this process with the added advantage of contributors being able to access their own data as required. Until the electronic links are established I would encourage you to continue to enter data personally or you may be fortunate enough to have a data entry person in your unit to whom you can delegate this responsibility. However you enter the data please use your specific login/ID so the patients/data can be traced back to you for your own analysis.
Data entry to National datasets is strongly supported by the Academy of the Royal Colleges and this form of central data collection will become a corner stone of revalidation/recertification and as such discussions continue with the Royal College of Surgeons to link the database to the RCS portfolio/logbook.
Finally, we are constantly exploring options to secure additional funding either from Industry partners or Government initiatives to facilitate National data collection. Additional funding will facilitate electronic national data collection and there is little doubt that if we, as a professional body, demonstrate our willingness and ability to collect data, it is much more likely that we will secure significant funding to facilitate the whole process.
Bariatric Audit Report
The National Bariatric Surgery Registry continues to accumulate data from UK bariatric surgical operations in both NHS and private hospitals. There have been over 10 000 operations uploaded onto the database in the first 24 months of the Registry. The first annual report will analyse data uploaded prior to March 31st 2010. The report is due for publication around the time of the BOMSS annual meeting in Wakefield in January 2011 and will provide the most comprehensive review of UK bariatric surgery to date. The excellent efforts of the many contributors are much appreciated.
National Oesophago-Gastric Cancer Audit:
Background
The Audit published its Third Annual Report at the beginning of November 2010. It concentrated on the results of the main prospective study and contained data on over 17,000 patients. In total it included data on over 3,800 resections, 3,600 courses of curative oncological therapy, 4,330 courses of palliative oncological therapy, and approximately 3,250 endoscopic / radiological palliative treatments. Overall case ascertainment was 71% and for surgical resections it was over 85%. All but four cancer centres provided enough information for their outcomes to be compared to the national average, and hence for the safety of their practice to be publicly demonstrated.
Overall, the results were very encouraging. Operative mortality has fallen significantly since the last AUGIS audit in 2002, chemotherapy completion rates are approaching those seen in clinical trials and the stent deployment success rate is nearly 100%. The Audit also contained centre-level data for four surgical outcomes: 30-day mortality, 90-day mortality, anastomotic leak rate and reoperation rate. We are pleased to report that no centre was outside the 99.8% control limits, indicating that surgery was being performed safely in all of those centres that had provided sufficient data.
The results contained in the Audit Report can now be used for providing up-to-date information to patients and for comparing local results with the national benchmarks. Where the results differ, hospitals can investigate this and thereby use the results to identify areas of potential improvement, hence improving the quality of the service they deliver. This was the primary objective of the Audit – to provide national information and hence facilitate and drive local quality improvement. The high-levels of case ascertainment meant that this is possible so a big thank-you to everyone who worked so hard to collect and enter data.
A detailed analysis and presentation of the results of the Audit is planned for the March 2011 meeting of the BSG. This will include comment from invited experts, both national and international, so we would encourage you to attend.
The future
Healthcare Quality Improvement Partnership (HQIP) has allocated funding for a new national oesophago-gastric cancer audit that will begin in April 2011. Further information will soon be sent to lead clinicians. The Audit will continue to be led clinically by Richard Hardwick (AUGIS) and Stuart Riley (BSG) and will be hosted by the RCS Clinical Effectiveness Unit.
If you have any further questions, please contact either Richard Hardwick (Richard.hardwick@addenbrookes.nhs.uk) or Tom Palser (tpalser@rcseng.ac.uk) and thank-you again for all of your hard work.
You will see from the above synopsis that the various National audits are progressing well and I would encourage all colleagues to enter data into their subspecialty audit.
Mr David P Berry
Chair of AUGIS Audit Committee