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News from the American College of Surgeons

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American College of Surgeons launches new Cancer Surgery Standards Program to improve the quality of surgical care provided to cancer patients

New program develops cancer surgery standards and reporting tools for institutions and surgeons to readily adopt and easily integrate into practice

CHICAGO (July 20, 2020): The American College of Surgeons (ACS) Cancer Programs today launched the Cancer Surgery Standards Program (CSSP), a new program that aims to improve the quality of surgical care provided to cancer patients by implementing standards for cancer surgery and standardizing the way operative data are documented and communicated.

An increasing body of evidence demonstrates that the adherence to specific operative techniques during cancer surgery directly improves key patient outcomes, including survival and quality of life. 1,2 "For example, we have evidence that shows that patients whose breast and gastric operations were performed to established technical standards live longer than patients whose operations did not," said Matthew H. G. Katz, MD, FACS, department of surgical oncology, The University of Texas MD Anderson Cancer Center, and Chair, CSSP. The CSSP will help to establish these evidence-based standards from clinical trials and research; educate surgeons, trainees, and staff to help them meet those standards; and build and disseminate tools, including synoptic operative report templates and associated electronic infrastructure, to support documentation and implementation and improve adherence.

The CSSP brings together experts in cancer surgery, cancer registry management, digital tools/frameworks, and surgical coding to develop synoptic operative reporting templates that standardize clinical documentation using a checklist format along with electronic documentation tools that can be used at the point-of-care. These templates and tools can be readily integrated into electronic health records, enabling surgeons to document the critical components of cancer operations efficiently and comprehensively.

Increased collaboration among multidisciplinary teams using standardized reporting is another important goal for this new program. "We have many different ways that we communicate about what occurs during a cancer operation. One of the things we want to do is create an opportunity for everyone to communicate effectively in a way that, when you read an operative note, you understand those critical elements that were performed, how they were performed, and whether or not they were performed," said Kelly Hunt, MD, FACS, Program Director, ACS CRP and Vice-Chair, CSSP.

Since its establishment in 1922, the ACS Commission on Cancer (CoC) has focused on decreasing the morbidity and mortality of patients with cancer by delivering the earliest possible diagnosis and best possible care wherever they live. The CoC advanced that goal with its first accreditation of cancer practices in 1931. With its rich history as pioneers of innovation that push the boundaries of surgical quality, the ACS and CoC are continuing their legacy by creating and implementing new cancer surgical standards with the CSSP. In the past decade, CoC accreditation standards have shifted from facilities and equipment to processes, toward outcomes-based standards leading up to the introduction last year of six new operative standards—two for breast cancer surgery, two for colorectal cancer surgery, and one each for lung cancer surgery and melanoma surgery.

The CSSP synoptic operative reporting tools will allow for easy monitoring of adherence to CoC standards and provide linkage to critical cancer and surgical codes. Additionally, these synoptic operative reporting tools and templates will ensure capture of the vital information that otherwise may be missing from narrative operative reports.3 In the future the CSSP tools will help automate data acquisition into the National Cancer Database, a joint program of the American College of Surgeons and American Cancer Society, which is the largest cancer registry of its kind.

"The CSSP will use evidence to develop best cancer surgery practices and will create and share clinical documentation tools that support the implementation of these surgical standards. The documentation tools will be designed to fit in the normal workflow and will incorporate the language of cancer and integrate into existing cancer databases," said Heidi Nelson, MD, FACS, Medical Director, ACS Cancer Programs. "Ultimately, the CSSP will serve as a definitive source for cancer surgery best practices."

"The new CSSP builds on the deep heritage and significant experience of the American College of Surgeons in setting standards to improve the quality of care for surgical patients, and it will lead how surgeons perform surgery in the future," said ACS Executive Director, David B. Hoyt, MD, FACS. "This new operative approach to care standards will revolutionize the way surgeons think about a technical surgical intervention to treat disease. These standards will also hold surgeons accountable through an electronic documentation system, and patients will benefit from better outcomes. Once these operative standards take hold in cancer care, patients can be assured to know that their surgeons are skilled practitioners in these optimal operative techniques."

In keeping with the College's commitment to quality, the development of these surgical standards and associated tools will allow surgeons and facilities to monitor adherence and review outcomes, ultimately leading to improved patient care.

"One of the most important things we're doing in the CSSP is not only creating and developing evidence-based standards, but also developing tools by which adherence to those standards can be monitored and achieved. We want to implement these standards and tools in such a way that surgeons can easily integrate them in their daily surgical practice," Dr. Katz concluded.

To learn more about the CSSP visit: https://www.facs.org/cssp.

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  1. Zhao B, Tsai C, Hunt KK, et al. Adherence to surgical and oncologic standards improves survival in breast cancer patients. J Surg Oncol. 2019 Aug;120(2):148-159. DOI: 10.1002/jso.25506
  2. Zhao B, Blair SL, Katz MHG, et al. Adherence with operative standards in the treatment of gastric cancer in the United States. Gastric Cancer. 2020 May;23(3):550-560. DOI:10.1007/s10120-019-01028-5.
  3. Bidwell SS, Merrell SB, Poles G, Morris AM. Implementation of a synoptic operative report for rectal cancer: a mixed-methods study. Dis Colon Rectum. 2020 Feb;63(2): 190-199. DOI: 10.1097/DCR.0000000000001518.

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About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 82,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.