In-Hospital Mortality and Complication Rates According to Health Insurance Data in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies in Germany

Abstract

Background Morbidity and in-hospital mortality rates of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Germany are not known. Methods From 2009 to 2018 all patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Germany were retrospectively analyzed regarding morbidity and in-hospital mortality rates according to nationwide hospital billing data based on diagnosis-related groups (DRG). The “failure to rescue” (FTR) index, characterizing patients who died after severe but potentially manageable complications, was calculated. Results In total, 8463 patients were included and analyzed. Female sex predominated (1.5:1). Colonic origin of peritoneal metastasis was highest throughout all years, reaching its highest level in 2017 (55%; n = 563) and its lowest level in 2012 (40%; n = 349). Median length of hospital stay reached its maximum in 2017 at 23.9 days and its minimum in 2010 at 22.0 days. Analysis of the total FTR index showed a noticeable improvement over the years, reaching its lowest values in 2017 (9.8%) and 2018 (8.8%). The FTR index for sepsis, peritonitis, and pulmonary complications significantly improved over time. Of the 8463 included patients, 290 died during hospital stay, reflecting an in-hospital mortality rate of 3.4%. Conclusion In-hospital mortality after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is reasonably low compared with other surgical procedures. The improvement in the FTR index reflects efforts to centralize treatment at specialized high-volume centers.

Twelve-Year Single Center Experience Shows Safe Implementation of Developed Peritoneal Surface Malignancy Treatment Protocols for Gastrointestinal and Gynecological Primary Tumors

“…These data once again highlight the importance of center experience in order to provide low-morbidity CRS and HIPEC [ 16 ]. Recently, health insurance data from Germany showed that over a 9-year period, the outcome of manageable but life-threatening complications after CRS and HIPEC significantly improved, resulting in a cumulative in-hospital mortality of 3.4% [ 15 ]. Data show that at least 141 procedures have to be performed to gain sufficient expertise [ 20 ].…”

“…In Germany, approximately 55% of HIPEC procedures were performed for CRC-PM patients in 2018 [ 15 ], and the literature provides 5-year survival rates of up to 54% in patients treated with CRS and HIPEC [ 35 ]. The impact of systemic chemotherapy on CRC-PM was evaluated by a large database analysis.…”

“…These parameters should allow for a proper patient selection and, in combination with a structured perioperative complication management, acceptable morbidity and mortality rates should be achievable. Recent data have shown that, over time, a lower percentage of patients died due to manageable but potentially life-threatening complications after CRS and HIPEC, suggesting a higher expertise in patient selection and complication management [ 15 ]. Furthermore, data showed that cumulative in-hospital mortality after CRS and HIPEC over a 9-year period was only 3.4% in Germany, which is lower than for oncologic pancreas, esophagus and liver surgery [ 15 ].…”

“…Recent data have shown that, over time, a lower percentage of patients died due to manageable but potentially life-threatening complications after CRS and HIPEC, suggesting a higher expertise in patient selection and complication management [ 15 ]. Furthermore, data showed that cumulative in-hospital mortality after CRS and HIPEC over a 9-year period was only 3.4% in Germany, which is lower than for oncologic pancreas, esophagus and liver surgery [ 15 ]. Center experience is another factor impacting on postoperative morbidity [ 16 ] after CRS and HIPEC, emphasizing the importance of high-volume centers.…”

Reply to: “Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Definitively Does Not Deserve Its Bad Reputation”

“…On the other hand, the authors provided from their point of view several conceptual frailties of our previous study. 2 The main difference between those two publications 1,2 is the frame of the database. The data from our study were extracted from the nationwide German diagnosis-related group (DRG) statistics hosted by the German Federal Statistics Office.…”