biostudies-literatureUnknown9(1)Verheul EM<h4>Background</h4>Comparison of quality indicators can improve quality of care. However, case-mix adjustment is deemed essential. The aim of this study was to develop and validate case-mix adjustment models and to evaluate the effect of case-mix adjustment for the quality indicators related to complications after breast cancer surgery.<h4>Methods</h4>Multivariable logistic regression with backward selection (P < 0.1) was used to develop case-mix models in patients undergoing breast cancer surgery (all types, breast-conserving surgery, mastectomy with or without immediate reconstruction) in the Netherlands (NABON Breast Cancer Audit). High-impact complications were defined as Clavien Dindo grade ≥3. Model performance was assessed using the area under the receiver operating characteristic cBJS openzrae147https://www.ebi.ac.uk/biostudies/studies/S-EPMC11793075biostudies-literatureHigh-impact complications after breast cancer surgery in the Dutch national quality registry: evaluating case-mix adjustment for hospital comparisons.PMC11793075Paez CGvan Hezewijk MDols LFCSchok Tvan Uden DJPVissers YLJKoppert LBVan Dessel ESchoenmaeckers EJPVolders JHden Hoed DMBijlsma RMLans TEMenke-Pluijmers MBEFrancken ABHeijns JBNeijenhuis PALingsma HFvan Klaveren Dvan der Vegt BKappers ISiesling SRakhorst HAFrakking TGLoo CESchipper RJTjan-Heijnen VCGHellingman AAVos EMeijer JDamen THCMartens MHVrancken Peeters MTFDBeek MAvan Sprundel TCBantema-Joppe EJNBCA consortiumVerbeek FPRHenneman Dvan Engelen Kvan den Hoven IHoven-Gondrie MLGordinou de Gouberville MCContant CMEStraver MEde Betue CTISiemerink ESchlooz-Vries MSchuttevaer HMoorman AMde Munck LVerheul EMVerloop JVan Bastelaar JHoornweg MJGooiker GABeelen KJBessems Mvan Deurzen CHMvan Eekeren RRJPJansen PMeeuwis CBosscher MRFfalseHigh-impact complications after breast cancer surgery in the Dutch national quality registry: evaluating case-mix adjustment for hospital comparisons.<h4>Background</h4>Comparison of quality indicators can improve quality of care. However, case-mix adjustment is deemed essential. The aim of this study was to develop and validate case-mix adjustment models and to evaluate the effect of case-mix adjustment for the quality indicators related to complications after breast cancer surgery.<h4>Methods</h4>Multivariable logistic regression with backward selection (P < 0.1) was used to develop case-mix models in patients undergoing breast cancer surgery (all types, breast-conserving surgery, mastectomy with or without immediate reconstruction) in the Netherlands (NABON Breast Cancer Audit). High-impact complications were defined as Clavien Dindo grade ≥3. Model performance was assessed using the area under the receiver operating characteristic c2024-01-01T00:00:00Z2024 Dec2025-04-04T07:26:23.432Z2025-04-04T07:26:23.432ZS-EPMC117930753990373410.1093/bjsopen/zrae147