British Journal of Oral and Maxillofacial Surgery 52 (2014) 913–921 Available online at www.sciencedirect.com Is benchmarking possible in audit of early outcomes after operations for head and neck cancer? David Tighe a,∗ , Isabel Sassoon b , A. Kwok c , Mark McGurk d a Department of Oral and Maxillofacial Surgery, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK b Dept of Informatics, King’s College Hospital, London, UK c Dept of Oral & Maxillofacial Surgery, Guys’ Hospital, London, UK d Oral & Maxillofacial Surgery, Guys’ Hospital, London, UK Received 2 April 2014; accepted 26 August 2014 Available online 15 September 2014 Abstract There is a need for a validated means of adjusting for case mix in morbidity audits of patients with cancer of the head and neck. To address this, we did a multicentre audit of 3 UK NHS cancer networks that treat patients with head and neck cancer, to compare the incidence of early adverse postoperative outcomes and to develop a means of adjusting for case mix. We did a retrospective and prospective audit of the case notes of 901 consecutive patients who had 1034 operations for squamous cell carcinoma (SCC) of the head and neck under general anaesthesia at 3 NHS hospitals. Analysis of raw data showed postoperative 30-day mortality (n = 17) to be consistent between sites (1.7%–1.9%) but 30-day complication rates varied more (34%–49%). Logistic regression models predicting morbidity discriminated well (area under the curve 0.74–0.76). Adjusted morbidity rates for the 3 units were compared on a funnel plot with 95% and 99% confidence intervals to account for random variation. It is possible to benchmark surgical performance by focusing on early postoperative outcomes in head and neck surgery. Morbidity is common and usually has a considerable impact on recovery, bed occupancy, cost, and the patient’s perception of the quality of care. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Audit; Surgical Outcomes; Case-mix adjustment; Benchmarking; Performance; HNSCC; Morbidity; Mortality Introduction In 2013 in the 10 surgical specialties in the United Kingdom (UK) published outcome audits on 30-day mortality and seri- ous complications, 1 but unlike the other surgical specialties, head and neck surgeons did not adjust for case mix. Postoperative morbidity leads to extended hospital stays and high costs of care, and in the United States the ∗ Corresponding author. Royal surrey County Hospital, Guildford, Oral & maxillofacial, Guildford, Guildford, United Kingdom. Tel.: +447791002164. E-mail addresses: dft1@doctors.org.uk (D. Tighe), Isabel.sassoon@kcl.ac.uk (I. Sassoon), abigailkwok@hotmail.co.uk (A. Kwok), Mark.mcgurk@kcl.ac.uk (M. McGurk). government and private insurance companies adjust tariffs for different units to limit reimbursement for that given after unexpected morbidity 2,3 Authors of recent large series from head and neck units have begun to work out the complex associations between patients’ characteristics, comorbidities, tumour factors, and type of operation, with the incidence of early adverse out- comes and prolonged hospital stay. 4–7 However, making meaningful comparisons between units remains a challenge. Nouraei et al 8 attempted a comparison using hospital episode statistics (HES), which depend on local clinical coders, and the Dr Foster methodology and expertise, to compare morbidity between head and neck units in the UK. They included over 10 000 serious operations on the head and neck between 2006 and 2011. Although http://dx.doi.org/10.1016/j.bjoms.2014.08.020 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.