Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

Voeten, Daan M.; Werf, Leonie R. van der; Sandick, Johanna W. van; Hillegersberg, Richard van; Henegouwen, Mark I. van Berge

doi:10.1007/s00464-020-08103-4

Cited by 13 publications

(9 citation statements)

References 43 publications

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“… 18–20 The median length of hospital stay decreased with the introduction of enhanced recovery programs and was 9 days for patients after an uncomplicated esophagectomy in the Netherlands, probably contributing to the decreased maximum hospital days to achieve textbook outcome. 21 , 22 Although these changes to the original textbook outcome seem to follow recent findings regarding esophageal cancer treatment in literature, no actual rationale for the inclusion of each of the items was provided by the responding surgeons.…”

Section: Discussionmentioning

confidence: 98%

Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure

Kalff

Henegouwen

Gisbertz

2021

Diseases of the Esophagus

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Summary Textbook outcome for esophageal cancer surgery is a composite quality measure including 10 short-term surgical outcomes reflecting an uneventful perioperative course. Achieved textbook outcome is associated with improved long-term survival. This study aimed to update the original textbook outcome based on international consensus. Forty-five international expert esophageal cancer surgeons received a personal invitation to evaluate the 10 items in the original textbook outcome for esophageal cancer surgery and to rate 18 additional items divided over seven subcategories for their importance in the updated textbook outcome. Items were included in the updated textbook outcome if ≥80% of the respondents agreed on inclusion. In case multiple items within one subcategory reached ≥80% agreement, only the most inclusive item with the highest agreement rate was included. With a response rate of 80%, 36 expert esophageal cancer surgeons, from 34 hospitals, 16 countries, and 4 continents responded to this international survey. Based on the inclusion criteria, the updated quality indicator ‘textbook outcome for esophageal cancer surgery’ should consist of: tumor-negative resection margins, ≥20 lymph nodes retrieved and examined, no intraoperative complication, no complications Clavien–Dindo ≥III, no ICU/MCU readmission, no readmission related to the surgical procedure, no anastomotic leakage, no hospital stay ≥14 days, and no in-hospital mortality. This study resulted in an international consensus-based update of a quality measure, textbook outcome for esophageal cancer surgery. This updated textbook outcome should be implemented in quality assurance programs for centers performing esophageal cancer surgery, and could standardize quality measures used internationally.

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Section: Discussionmentioning

confidence: 98%

Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure

Kalff

Henegouwen

Gisbertz

2021

Diseases of the Esophagus

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“…For LOS, we elected to only plot US-based studies in the analysis figures because of known international variations in LOS. 25 , 26 , 27 , 28 We reported total postoperative complications (or major complications) when available. Long-term oncologic outcomes of interest were cancer recurrence and disease-free survival (DFS).…”

Section: Methodsmentioning

confidence: 99%

Comparison of Clinical Outcomes of Robot-Assisted, Video-Assisted, and Open Esophagectomy for Esophageal Cancer

et al. 2021

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“…In addition, recurrencefree and overall cancer-related survival are negatively affected by postoperative complications. 6,7 The implementation of Enhanced Recovery After Surgery (ERAS) protocols reduces postoperative complication rates. 8 Further reduction of major complications may be achieved by tailormade perioperative care using personalized prehabilitation programs.…”

mentioning

confidence: 99%

Patient-Related Prognostic Factors for Anastomotic Leakage, Major Complications, and Short-Term Mortality Following Esophagectomy for Cancer: A Systematic Review and Meta-Analyses

et al. 2021

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Objective The aim of this study is to identify preoperative patient-related prognostic factors for anastomotic leakage, mortality, and major complications in patients undergoing oncological esophagectomy. Background Esophagectomy is a high-risk procedure with an incidence of major complications around 25% and short-term mortality around 4%. Methods We systematically searched the Medline and Embase databases for studies investigating the associations between patient-related prognostic factors and anastomotic leakage, major postoperative complications (Clavien–Dindo ≥ IIIa), and/or 30-day/in-hospital mortality after esophagectomy for cancer. Results Thirty-nine eligible studies identifying 37 prognostic factors were included. Cardiac comorbidity was associated with anastomotic leakage, major complications, and mortality. Male sex and diabetes were prognostic factors for anastomotic leakage and major complications. Additionally, American Society of Anesthesiologists (ASA) score > III and renal disease were associated with anastomotic leakage and mortality. Pulmonary comorbidity, vascular comorbidity, hypertension, and adenocarcinoma tumor histology were identified as prognostic factors for anastomotic leakage. Age > 70 years, habitual alcohol usage, and body mass index (BMI) 18.5–25 kg/m2 were associated with increased risk for mortality. Conclusions Various patient-related prognostic factors are associated with anastomotic leakage, major postoperative complications, and postoperative mortality following oncological esophagectomy. This knowledge may define case-mix adjustment models used in benchmarking or auditing and may assist in selection of patients eligible for surgery or tailored perioperative care.

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Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

Cited by 13 publications

References 43 publications

Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure

Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure

Comparison of Clinical Outcomes of Robot-Assisted, Video-Assisted, and Open Esophagectomy for Esophageal Cancer

Patient-Related Prognostic Factors for Anastomotic Leakage, Major Complications, and Short-Term Mortality Following Esophagectomy for Cancer: A Systematic Review and Meta-Analyses

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