Table 3.
Moderate-validity pancreatic cancer quality indicators*
| No. | Quality indicator | Median ranking | Level of measurement | Domain |
| 30 | IF an institution treats pancreatic cancer, THEN the institution should participate in clinical trials | 7.5 | Hospital | Structure |
| 31 | IF an institution performs pancreatic cancer surgery, THEN the institution should perform ≥12 cases per year | 8 | Hospital | Structure |
| 32 | IF an institution performs pancreatic cancer surgery, THEN the hospital should have endoscopic ultrasonography services available on site | 7 | Hospital | Structure |
| 33 | IF an institution treats pancreatic cancer, THEN the institution should have radiation therapy and chemotherapy services available within their institution | 8 | Hospital | Structure |
| 34 | IF an institution performs pancreatic cancer surgery, THEN the hospital should have ERCP services available on site | 8 | Hospital | Structure |
| 35 | If a patient is to undergo resection, THEN on the basis of the CT or MRI scan, the surgeon should preoperatively document 1) no metastatic disease, 2) patent superior mesenteric vein and portal vein, and 3) a definable tissue plane between the tumor and regional arterial structures | 9 | Patient | Process |
| 36 | IF a patient undergoes cancer-directed resection, THEN the margins should be macroscopically clear | 8 | Patient | Process |
| 37 | IF a patient undergoes resection, THEN in the operative note, the surgeon should document intraoperative findings including the absence of 1) regional arterial involvement, 2) metastatic disease (liver, peritoneal, omental), and 3) distant adenopathy | 8.5 | Patient | Process |
| 38 | IF a patient undergoes cancer-directed resection, THEN ≥10 regional lymph nodes should be resected and pathologically evaluated† | 8 | Patient | Process |
| 39 | IF an institution performs pancreatic cancer surgery, THEN the institution should monitor their median estimated blood loss | 8 | Hospital | Process |
| 40 | IF an institution performs pancreatic cancer surgery, THEN the institution should monitor the median operative time for resections | 8 | Hospital | Efficiency |
| 41 | IF an institution performs pancreatic cancer surgery, THEN the hospital should monitor their readmission-within-30-days rate | 8 | Hospital | Efficiency |
| 42 | IF a patient undergoes resection, THEN the operative time should be less than 10 hours‡ | 8 | Patient | Efficiency |
| 43 | IF an institution performs pancreatic cancer surgery, THEN the hospital should monitor the stage-specific 2-year and 5-year survival rates for their patients who underwent pancreatectomy | 8 | Hospital | Outcome |
Based on relaxed validity criteria (≥95% of expert panel rankings in 4–9 range). ERCP = endoscopic retrograde cholangiopancreatography; CT = computed tomography; MRI = magnetic resonance imaging.
The expert panel extensively discussed indicators with multiple nodal count thresholds, but the only indicator retained was for the resection and examination of greater than or equal to 10 nodes. The indicator for greater than or equal to 12 nodes was also moderately valid but had lower median score; thus, the indicator for greater than or equal to 10 nodes was retained. The indicator for greater than or equal to 15 nodes was ranked as not valid.
The expert panel discussed a variety of time thresholds and thought that 8 hours would be a reasonable maximum, but they settled on 10 hours because many panel members believed that operative times greater than 8 hours would not be excessive.