Key result
Textbook outcome in colorectal surgery was achieved in a pooled rate of 55% (95% CI 54-55%), with no significant difference between elective and mixed case loads.
Why the study?
No review had synthesised the evidence regarding the elements surgeons use to define textbook outcome (TO) composite measures and the rates of TO achieved in surgery.
Does achievement of Textbook Outcome improve post-operative outcomes in adult patients undergoing colorectal surgery?
Meta-Analysis (n=301,502)
Does achievement of Textbook Outcome improve post-operative outcomes in adult patients undergoing colorectal surgery?
Textbook outcome is achieved in approximately 55% of colorectal surgeries, highlighting its potential as a quality improvement measure despite the current lack of a standardized definition.
Supports textbook outcome as a quality metric in colorectal surgery; extends prior reports despite definitional heterogeneity.
BACKGROUND: Textbook outcome (TO) is a composite measure used in surgery to evaluate post operative outcomes. No review has synthesised the evidence in relation to TO regarding the elements surgeons are utilising to inform their TO composite measure and the rates of TO achieved. METHODS: Our systematic review and meta analysis was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. PubMed, EMBASE, and Cochrane central registry of controlled trials were searched up to 8th November 2023. Pooled proportions of TO, clinical factors considered and risk factors in relation to TO are reported. RESULTS: Fifteen studies with 301,502 patients were included in our systematic review while fourteen studies comprising of 247,843 patients were included in our meta-analysis. Pooled rates of TO achieved were 55% with a 95% confidence interval (95% CI) of 54-55%. When stratified by elective versus mixed case load, rates were 56% (95% CI 49-62) and 54% (95% CI 50-58), respectively. Studies reported differing definitions of TO. Reported predictors of achieving TO include age, left sided surgery and elective nature. CONCLUSIONS: TO is achieved, on average in 55% of reported cases and it may predict short and long term post operative patient outcomes. This study did not detect a difference in rates between elective versus mixed case load TO proportions. There is no standardised definition in use of TO. Standardisation of the composite is likely required to enable meaning comparison using TO in the future and a Delphi consensus is warranted.
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Curtain et al. (2024) conducted a meta-analysis in Colorectal surgery (n=301,502). Textbook outcome (TO) was evaluated on Pooled rates of Textbook outcome (TO) achieved (95% CI 54-55). Textbook outcome in colorectal surgery was achieved in a pooled rate of 55% (95% CI 54-55%), with no significant difference between elective and mixed case loads.
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