Identification of the clinically most relevant postoperative complications after gastrectomy: a population-based cohort study

Abstract

Background Postoperative complications frequently occur after gastrectomy for gastric cancer and are associated with poor clinical outcomes, such as mortality and reoperations. The aim of study was to identify the clinically most relevantcomplications after gastrectomy, using the population-attributable fraction (PAF). Methods Between 2011 and 2017, all patients who underwent potentially curative gastrectomy for gastric adenocarcinoma were included from the Dutch Upper GI Cancer Audit. Postoperative outcomes (morbidity, mortality, recovery and hospitalization) were evaluated. The prevalence of postoperative complications (e.g., anastomotic leakage and pneumonia) and of the study outcomes were calculated. The adjusted relative risk and Confidence Interval (CI) for each complication-outcome pair were calculated. Subsequently, the PAF was calculated, which represents the percentage of a given outcome occurring in the population, caused by individual complications, taking both the relative risk and the frequency in which a complication occurs into account. Results In total, 2176 patients were analyzed. Anastomotic leakage and pulmonary complications had the greatest overall impact on postoperative mortality (PAF 29.2% [95% CI 19.3-39.1] and 21.6% [95% CI 10.5-32.7], respectively) and prolonged hospitalization (PAF 12.9% [95% CI 9.7-16.0] and 14.7% [95% CI 11.0-18.8], respectively). Anastomotic leakage had the greatest overall impact on re-interventions (PAF 25.1% [95% CI 20.5-29.7]) and reoperations (PAF 30.3% [95% CI 24.3-36.3]). Intra-abdominal abscesses had the largest impact on readmissions (PAF 7.0% [95% CI 3.2-10.9]). Other complications only had a small effect on these outcomes. Conclusion Surgical improvement programs should focus on preventing or managing anastomotic leakage and pulmonary complications, since these complications have the greatest overall impact on clinical outcomes after gastrectomy.

Incidence and Grading of Complications After Gastrectomy for Cancer Using the GASTRODATA Registry

“…from the DUCA registry. 7 There is no obvious line of action regarding some of the most frequent postoperative general complications, such as infections and major respiratory problems. One suggestion would be to collect preoperative swabs from the cutis, mouth, stool, and urine from pre-hospitalized patients undergoing surgery as a way to reduce postoperative infections.…”

“…Many clinical series indicate that postoperative courses differ significantly between eastern and western centers, with 30-day mortality rates being around 1% 5,6 and 5%, respectively. 7,8 The driving factors behind this difference have not been clarified, being possibly due to both patient-and surgeon-related features. 9 While mortality is easier to quantify, the reporting of morbidity rates has notably suffered from the lack of a standardized system, with morbidity rates ranging from 10% to 40%.…”

Impact of Type of Postoperative Complications on Long-Term Survival of Gastric Cancer Patients: Results From a High-Volume Institution in China

“…However, these studies failed to exclude patients who died in a short postoperative period. It is important to note that postoperative complications increase early mortality, which would overshadow the real influence of complications on long-term survival of cancer patients ( 33 , 34 ). Besides, these reports ( 14 , 17 , 35 , 36 ) did not discriminate which type of complication was the real risk factor for decreased long-term survival.…”

Postoperative morbidity and quality of life between totally laparoscopic total gastrectomy and laparoscopy-assisted total gastrectomy: a propensity-score matched analysis

“…The postoperative pulmonary complication was reported as one of the greatest risk factors for postoperative mortality in gastric cancer patients [ 12 , 23 , 24 ]. In addition, total gastrectomy was an independent risk factor for pulmonary complications following laparoscopic gastrectomy [ 13 ].…”