{"entity":{"id":"idea-fund-surgical-outcomes-public-reporting","kind":"idea","name":"Public risk-adjusted outcome reporting for cancer surgery to drive centralisation","aka":[],"tldr":"Where you have your cancer operation strongly affects whether you survive it. Publishing each hospital's adjusted results would push complex surgery towards the centres that do it well.","summary":"National mandatory reporting of risk-adjusted 90-day mortality, major complications, margin status, lymph node yield and volume for the most complex cancer operations (oesophagectomy, pancreatectomy, gastrectomy, cystectomy, hepatectomy, lung resection), published by hospital and, for high-volume procedures, by surgeon, with minimum volume thresholds for commissioning. The volume-outcome relationship in complex cancer surgery is among the most robust findings in health services research; the Netherlands, Denmark and parts of England have centralised and improved mortality. Public reporting plus commissioning thresholds is a policy lever that requires no new science and little money.","asOf":"2026-09-08","links":[{"label":"ACS NSQIP","url":"https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/"}],"tags":[],"related":["idea-fund-surgical-video-registry","idea-fund-device-technique-registry"],"cancers":["esophageal","pancreatic","gastric","urothelial"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["nki"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-surgery-radiation-innovation","b-care-fragmentation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Mandatory public reporting with volume thresholds reduces 90-day mortality for oesophagectomy and pancreatectomy by at least a quarter within three years through centralisation and quality improvement, without reducing access measured by resection rates.","rationale":"Dutch centralisation of oesophageal and pancreatic surgery reduced mortality substantially; the Netherlands' DICA audit and Sweden's registries show public, audited outcomes drive improvement. Many systems still permit very low-volume complex cancer surgery.","test":"Introduce reporting and thresholds in one country and compare mortality, complication and resection rates with the preceding period and with a country without reporting.","maturity":"being-tested-at-scale","actor":"policy","cost":"small","horizonYears":3},"route":"/ideas/idea-fund-surgical-outcomes-public-reporting/","neighbours":{"idea":[{"id":"idea-fund-surgical-video-registry","kind":"idea","name":"A video-based surgical quality registry linking assessed skill to cancer outcomes","route":"/ideas/idea-fund-surgical-video-registry/"},{"id":"idea-fund-device-technique-registry","kind":"idea","name":"Mandatory staged registries for new surgical techniques before wide adoption","route":"/ideas/idea-fund-device-technique-registry/"}],"cancer":[{"id":"urothelial","kind":"cancer","name":"Bladder & urothelial cancer","route":"/cancers/urothelial/"},{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"esophageal","kind":"cancer","name":"Oesophageal cancer","route":"/cancers/esophageal/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"institution":[{"id":"nki","kind":"institution","name":"Netherlands Cancer Institute (NKI-AvL)","route":"/institutions/nki/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}]}}