Failure-to-rescue in patients undergoing surgery for esophageal or gastric cancer

Busweiler, Linde A. D.; Henneman, D.; Dikken, Johan L.; Fiocco, Marta; Henegouwen, Mark I. van Berge; Wijnhoven, Bas P. L.; Hillegersberg, Richard van; Rosman, Camiel; Wouters, Michel W.J.M.; Sandick, Johanna W. van; Bosscha, K.; Cats, A.; Grieken, Nicole C. van; Hartgrink, Henk H.; Lemmens, Valery; Nieuwenhuijzen, G.; Plukker, John Theodorus; Siersema, Peter D.; Tetteroo, G. W. M.; Veldhuis, P.; Voncken, Francine E.M.

doi:10.1016/j.ejso.2017.07.005

Cited by 61 publications

(49 citation statements)

References 33 publications

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“…‘Failure to rescue’ is a well known phenomenon, impacting on short‐term survival after oesophagectomy, and possibly explaining differences in mortality between high‐ and low‐volume centres. Failure to identify complications early and treat patients may also contribute to a long‐term impact of complications on patient survival.…”

Section: Discussionmentioning

confidence: 99%

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

et al. 2020

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Background: Recent evidence suggests that complications after oesophagectomy may decrease shortand long-term survival of patients with oesophageal cancer. This study aimed to analyse the impact of complications on survival in a Western cohort. Methods: Complications after oesophagectomy were recorded for all patients operated on between January 2006 and February 2017, with severity defined using the Clavien-Dindo classification. Associations between complications and overall and recurrence-free survival were assessed using univariable and multivariable Cox regression models. Results: Of 430 patients, 292 (67⋅9 per cent) developed postoperative complications, with 128 (39⋅8 per cent) classified as Clavien-Dindo grade III or IV. No significant associations were detected between Clavien-Dindo grade and either tumour (T) (P = 0⋅071) or nodal (N) status (P = 0⋅882). There was a significant correlation between Clavien-Dindo grade and ASA fitness grade (P = 0⋅032). In multivariable analysis, overall survival in patients with Clavien-Dindo grade I complications was similar to that in patients with no complications (hazard ratio (HR) 0⋅97, P = 0⋅915). However, patients with grade II and IV complications had significantly shorter overall survival than those with no complications: HR 1⋅64 (P = 0⋅007) and 1⋅74 (P = 0⋅013) respectively. Conclusion: Increasing severity of complications after oesophagectomy was associated with decreased overall survival. Prevention of complications should improve survival.Funding information Queen Elizabeth Hospital Birmingham Charity (Upper Gastrointestinal Fund) Upper G.I. Blues of the consensus reporting guidelines on oesophageal complications 11 , a lack of standardization of complication reporting made understanding the relationship between complications and long-term survival difficult.

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Section: Discussionmentioning

confidence: 99%

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

et al. 2020

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“…In particular, anastomotic leaks occur in up to 20 per cent of patients, pulmonary complications in up to 35 per cent and cardiovascular complications in up to 15 per cent. These complications result in increased duration of hospital stay and perioperative mortality. Evidence from colorectal cancer resection clearly shows that complications such as anastomotic leak decrease overall survival (OS) and disease‐free survival (DFS).…”

Section: Introductionmentioning

confidence: 99%

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Saunders

Yanni

Dorrington

et al. 2020

Journal of British Surgery

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Background: Postoperative complications after resection of oesophagogastric carcinoma can result in considerable early morbidity and mortality. However, the long-term effects on survival are less clear. Methods: All patients undergoing intentionally curative resection for oesophageal or gastric cancer between 2006 and 2016 were selected from an institutional database. Patients were categorized by complication severity according to the Clavien-Dindo classification (grades 0-V). Complications were defined according to an international consensus statement. The effect of leak and severe non-leak-related complications on overall survival, recurrence and disease-free survival was assessed using Kaplan-Meier analyses to evaluate differences between groups. All factors significantly associated with survival in univariable analysis were entered into a Cox multivariable regression model with stepwise elimination. Results: Some 1100 patients were included, with a median age of 69 (range 28-92) years; 48⋅1 per cent had stage III disease and cancer recurred in 428 patients (38⋅9 per cent). Complications of grade III or higher occurred in 244 patients (22⋅2 per cent). The most common complications were pulmonary (29⋅9 per cent), with a 13⋅0 per cent incidence of pneumonia. Rates of atrial dysrhythmia and anastomotic leak were 10⋅0 and 9⋅6 per cent respectively. Patients with a grade III-IV leak did not have significantly reduced overall survival compared with those who had grade 0-I complications. However, patients with grade III-IV non-leak-related complications had reduced median overall survival (19⋅7 versus 42⋅7 months; P < 0⋅001) and disease-free survival (18⋅4 versus 36⋅4 months; P < 0⋅001). Cox regression analysis identified age, tumour stage, resection margin and grade III-IV non-leak-related complications as independent predictors of poor overall and disease-free survival. Conclusion: Beyond the acute postoperative period, anastomotic leak does not adversely affect survival, however, other severe postoperative complications do reduce long-term overall and disease-free survival. Statistical analysisContinuous variables are described as median (i.q.r. or range) or mean(s.d.), and were compared using the Mann-Whitney U test and Student's t test respectively. The χ 2 test was used for analysis of discrete data. OS was

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“…These findings are also in line with various international analyses of other complex surgical procedures. [27][28][29][30] Post-hepatectomy liver failure (PHLF) is known to be a major cause of perioperative death. In the present analysis the incidence of clinically relevant PHLF (grade B and C) was 7.2% following major resections.…”

Section: Discussionmentioning

confidence: 99%

In-hospital Mortality and Failure to Rescue Following Hepatobiliary Surgery in Germany - A Nationwide Analysis.

Krautz

Gall

Gefeller

et al. 2020

Preprint

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Background: Recent observational studies on volume-outcome associations in hepatobiliary surgery were not designed to account for the varying extent of hepatobiliary resections and the consequential risk of perioperative morbidity and mortality. Therefore, this study aimed to determine the risk-adjusted in-hospital mortality for minor and major hepatobiliary resections at the national level in Germany and to examine the effect of hospital volume on in-hospital mortality, and failure to rescue. Methods: All inpatient cases of hepatobiliary surgery (n = 31,114) in Germany from 2009 to 2015 were studied using national hospital discharge data. After ranking hospitals according to increasing hospital volumes, five volume categories were established based on all hepatobiliary resections. The association between hospital volume and in-hospital mortality following minor and major hepatobiliary resections was evaluated by multivariable regression methods. Results: Minor hepatobiliary resections were associated with an overall mortality rate of 3.9% and showed no significant volume-outcome associations. In contrast, overall mortality rate of major hepatobiliary resections was 10.3%. In this cohort, risk-adjusted in-hospital mortality following major resections varied widely across hospital volume categories, from 11.4% (95% CI 10.4–12.5) in very low volume hospitals to 7.4% (95% CI 6.6–8.2) in very high volume hospitals (risk-adjusted OR 0.59, 95% CI 0.41–0.54). Moreover, rates of failure to rescue decreased from 29.38% (95% CI 26.7-32.2) in very low volume hospitals to 21.38% (95% CI 19.2-23.8) in very high volume hospitals. Conclusions: In Germany, patients who are undergoing major hepatobiliary resections have improved outcomes, if they are admitted to higher volume hospitals. However, such associations are not evident following minor hepatobiliary resections. Following major hepatobiliary resections, 70-80% of the excess mortality of the very low volume hospitals was estimated to be attributable to failure to rescue.

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Failure-to-rescue in patients undergoing surgery for esophageal or gastric cancer

Cited by 61 publications

References 33 publications

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

In-hospital Mortality and Failure to Rescue Following Hepatobiliary Surgery in Germany - A Nationwide Analysis.

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