Key performance indicators for improving outcomes from retroperitoneal sarcoma surgery in New Zealand.

Background: Retroperitoneal sarcomas are a rare and heterogenous group of tumours. There is increasing evidence that high volume sarcoma units achieve superior outcomes than low volume units. Due to the relatively small population, New Zealand is unlikely to generate a sufficient case volume to be considered high volume. To our knowledge, no well-established key performance indicators (KPIs) exist for retroperitoneal sarcoma surgery. In order to ensure quality standards we aim to propose KPIs which will act as a benchmark and a target for future quality improvement.

Methods: Potential KPIs were generated by internal discussion within the sarcoma team, taking into consideration available guidelines and evidence. Cases treated through the unit since 2015 were audited to determine historical performance against these KPIs.

Results: Eighty-six patients with primary retroperitoneal sarcomas were identified. 69% of patients were discussed at the sarcoma MDM prior to treatment, 62% underwent preoperative core biopsy. 82% of patients were seen and treated within target timeframes set by the Ministry of Health. 53% of patients underwent surgery with a sarcoma trained surgeon. R0/R1 rate was 88%. 90-day mortality was 4.6%.

Conclusions: Surgical treatment of retroperitoneal sarcomas is complex and can be associated with significant morbidity. The proposed KPIs provide a measure of service performance and provide targets for quality improvement.