Accordion Severity Grading System: Assessment of Relationship Between Costs, Length of Hospital Stay, and Survival in Patients with Complications after Esophagectomy for Cancer

Carrott, Philip W.; Markar, Sheraz R.; Kuppusamy, Madhan Kumar; Traverso, L. William; Low, Donald E.

doi:10.1016/j.jamcollsurg.2012.04.030

Cited by 48 publications

(47 citation statements)

References 8 publications

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“…However, it should be noted that, for the purposes of this study, we did not differentiate severity of complications. Complication severity grade has been found to significantly increase hospital costs [19]. The relationship of postoperative complications on hospital costs may be related to different types of complications or their severity.…”

Section: Discussionmentioning

confidence: 99%

Complications, Not Minimally Invasive Surgical Technique, Are Associated with Increased Cost after Esophagectomy

Ginsberg

et al. 2016

Minimally Invasive Surgery

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Background. Minimally invasive esophagectomy (MIE) techniques offer similar oncological and surgical outcomes to open methods. The effects of MIE on hospital costs are not well documented. Methods. We reviewed the electronic records of patients who underwent esophagectomy at a single academic institution between January 2012 and December 2014. Esophagectomy techniques were grouped into open, hybrid, MIE, and transhiatal (THE) esophagectomy. Univariate and multivariate analyses were performed to assess the impact of surgery on total hospital cost after esophagectomy. Results. 80 patients were identified: 11 THE, 11 open, 41 hybrid, and 17 MIE. Median total cost of the hospitalization was $31,375 and was similar between surgical technique groups. MIE was associated with higher intraoperative costs, but not total hospital cost. Multivariable analysis revealed that the presence of a complication, increased age, American Society of Anesthesiologists class IV (ASA4), and preoperative coronary artery disease (CAD) were associated with significantly increased cost. Conclusions. Despite the association of MIE with higher operation costs, the total hospital cost was not different between surgical technique groups. Postoperative complications and severe preoperative comorbidities are significant drivers of hospital cost associated with esophagectomy. Surgeons should choose technique based on clinical factors, rather than cost implications.

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Section: Discussionmentioning

confidence: 99%

Complications, Not Minimally Invasive Surgical Technique, Are Associated with Increased Cost after Esophagectomy

Ginsberg

et al. 2016

Minimally Invasive Surgery

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“…Since then, a further 12 reports have evaluated the relationship between postoperative complications and cancer survival after esophagogastric resection [1,[5][6][7][9][10][11][12]16,[18][19][20][21] (Table 2). Many of the studies included early postoperative mortality in the analysis.…”

Section: Discussionmentioning

confidence: 99%

“…This grouping allows meaningful comparisons to be made between centers and between different surgical specialties [17]. Six studies have employed the Clavien-Dindo classification to report complications after esophagectomy or gastrectomy [18][19][20][27][28][29][30] (Table 3). The reported frequency of complications range from 51-70% for esophagectomy and 25-40% for gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

“…A number of smaller studies have examined the potential relationship between perioperative outcome and cancer relapse [4][5][6][7][8][9][10][11][12][13][14][15][16], in patients undergoing esophagogastric resection. The findings have been conflicting, with seven of 13 studies reporting a significantly poorer longterm survival for those suffering postoperative complications compared to their counterparts, while six studies failed to identify a significant difference in survival.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Postoperative Morbidity on Longterm Cancer Survival after Esophagogastric Resection

S¹

2014

J Gastroint Dig Syst

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Background: Previous studies have shown that postoperative adverse events after colorectal resection predict a poor prognosis with early cancer relapse. The aim of this study was to report the outcome of patients undergoing esophagogastric resection to assess the influence of in-hospital factors on long-term cancer survival. Specifically, a standardized definition of complications was applied to this cohort and mortalities within the first 90 days were excluded from the analysis in order to remove any bias this would have.

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“…Despite this, postoperative complications have been associated with decreased oncologic overall survival after cancer surgery [44,45,46]. Several complications may arise in gastroesophageal cancer surgery, among them anastomotic leakages and pulmonary complications requiring intensive care treatment in many cases.…”

Section: Enhanced Recovery After Surgerymentioning

confidence: 99%

Feeding Challenges in Patients with Esophageal and Gastroesophageal Cancers

Reim

Frieß

2015

Gastrointest Tumors

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Background: Patients undergoing treatment for esophagogastric or esophageal cancer are exposed to a considerably high risk of malnutrition due to early obstruction of the gastrointestinal passage. Presently most of the patients undergo modern multimodal therapies which require chemoradiation or chemotherapy ahead of surgery. Therefore reconstruction of the obstructed gastrointestinal passage is considerably delayed. Surgery as the only curative option after neoadjuvant treatment is the mainstay of therapy in this setting. However, many patients are at risk for the development of postoperative complications associated with the complexity of the surgical procedure. Therefore enteral feeding as a prerequisite to avoid malnutrition represents a special therapeutic challenge. Summary: This review describes the recent literature on the incidence and influence of perioperative malnutrition on oncologic outcome, measures to determine patients at risk, possible strategies to reduce or avoid malnutrition by supportive enteral/parenteral nutrition, implementation of the enhanced recovery after surgery programs and feeding routes, but also surgical and adjuvant procedures in the curative and palliative setting for patients undergoing treatment for gastroesophageal cancers. Key Messages: Appropriate identification of patients at risk is crucial to avoid malnutrition. Early nutritional interventions during multimodal/neoadjuvant treatment may be beneficial for weight loss reduction although the evidence is not conclusive. Pouch reconstructions during surgery should be applied in order to increase quality of life and eating capacity. Reduction of postoperative complications could provide potential benefits. In palliative patients, insertion of self-expanding metal stents can reduce dysphagia and improve quality of life, but does not prolong overall survival. Further evidence is required to determine the value of the procedures and measures described in this review. Practical Implications: Nutritional risk scoring should be performed for every gastroesophageal cancer patient. Sophisticated reconstruction methods and early recovery programs should be enforced to reduce perioperative starvation periods. Self-expanding metal stents should be used for palliative patients.

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Accordion Severity Grading System: Assessment of Relationship Between Costs, Length of Hospital Stay, and Survival in Patients with Complications after Esophagectomy for Cancer

Cited by 48 publications

References 8 publications

Complications, Not Minimally Invasive Surgical Technique, Are Associated with Increased Cost after Esophagectomy

Complications, Not Minimally Invasive Surgical Technique, Are Associated with Increased Cost after Esophagectomy

Influence of Postoperative Morbidity on Longterm Cancer Survival after Esophagogastric Resection

Feeding Challenges in Patients with Esophageal and Gastroesophageal Cancers

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