Quality of surgical care of pancreatic cancer in a single payer North American health care system [version 1; referees: 1 approved, 1 approved with reservations]

Introduction: Quality of surgical care of Canadian patients with pancreatic cancer (PC) is inadequately known. Primary aim of this study was to analyze the quality of care received by patients who underwent resections of PC in Nova Scotia over a 10-year period (2001-2011). Methods: All patients with PC (n. 1094) were identified using provincial cancer registries and only adult patients with resectable disease were included in the study (n. 109). Well established disease-specific quality indicators (QIs) were used as references. The proportion of patients who met those QIs was calculated. The average and 95 % confidence intervals of QIs were compared between patients treated in Nova Scotia and published references. Results: Surgical therapy was performed in 9.9 % of patients. Perioperative morbidity and mortality occurred in 25 % and 5 % of patients respectively. Overall survival was 57 % at 1 year, 18 % at 3 year and 9 % at 5 year. R1 resections occurred in 38 % of patients. When compared to published quality measures, patients in Nova Scotia had similar outcomes except for an inferior number of lymph nodes found in the surgical specimens (9 vs. 19; P < 0.05). On the other hand, a significant proportion of patients did not fully meet several QIs linked to preoperative, surgical pathology and postoperative care. Conclusions: In Nova Scotia, the proportion of patients who underwent surgery for PC was lower than expected. Although perioperative morbidity, mortality and survival rates were comparable to published references, many did not meet established standard QIs.