TY - JOUR
T1 - Impact of postoperative complications on outcomes after oesophagectomy for cancer
AU - Goense, L
AU - Meziani, J
AU - Ruurda, J P
AU - van Hillegersberg, R
N1 - Funding Information:
L.G. and J.M. contributed equally to this work. The authors thank all surgeons, registrars, physician assistants and administrative nurses for data registration in the DUCA database, as well as the DUCA group for scientific input. This paper reports the results of a preregistered study with complete analysis plans (https://www.dica.nl/duca/onderzoek). The authors certify that the results of all preregistered analyses are reported. Because of the sensitive nature of the data collected for this study, requests to access the data set from qualified researchers trained in human subject confidentiality protocols may be sent to the DUCA at [email protected]. Disclosure: The authors declare no conflict of interest.
Publisher Copyright:
© 2018 BJS Society Ltd Published by John Wiley & Sons Ltd
PY - 2019/1
Y1 - 2019/1
N2 - BACKGROUND: To allocate healthcare resources optimally, complication-related quality initiatives should target complications that have the greatest overall impact on outcomes after surgery. The aim of this study was to identify the most clinically relevant complications after oesophagectomy for cancer in a nationwide cohort study.METHODS: Consecutive patients who underwent oesophagectomy for cancer between January 2011 and December 2016 were identified from the Dutch Upper Gastrointestinal Cancer Audit. The adjusted population attributable fraction (PAF) was used to estimate the impact of specific postoperative complications on the clinical outcomes postoperative mortality, reoperation, prolonged hospital stay and readmission to hospital in the study population. The PAF represents the percentage reduction in the frequency of a given outcome (such as death) that would occur in a theoretical scenario where a specific complication (for example anastomotic leakage) was able to be prevented completely in the study population.RESULTS: Some 4096 patients were analysed. Pulmonary complications and anastomotic leakage had the greatest overall impact on postoperative mortality (risk-adjusted PAF 44·1 and 30·4 per cent respectively), prolonged hospital stay (risk-adjusted PAF 31·4 and 30·9 per cent) and readmission to hospital (risk-adjusted PAF 7·3 and 14·7 per cent). Anastomotic leakage had the greatest impact on reoperation (risk-adjusted PAF 47·1 per cent). In contrast, the impact of other complications on these outcomes was relatively small.CONCLUSION: Reducing the incidence of pulmonary complications and anastomotic leakage may have the greatest clinical impact on outcomes after oesophagectomy.
AB - BACKGROUND: To allocate healthcare resources optimally, complication-related quality initiatives should target complications that have the greatest overall impact on outcomes after surgery. The aim of this study was to identify the most clinically relevant complications after oesophagectomy for cancer in a nationwide cohort study.METHODS: Consecutive patients who underwent oesophagectomy for cancer between January 2011 and December 2016 were identified from the Dutch Upper Gastrointestinal Cancer Audit. The adjusted population attributable fraction (PAF) was used to estimate the impact of specific postoperative complications on the clinical outcomes postoperative mortality, reoperation, prolonged hospital stay and readmission to hospital in the study population. The PAF represents the percentage reduction in the frequency of a given outcome (such as death) that would occur in a theoretical scenario where a specific complication (for example anastomotic leakage) was able to be prevented completely in the study population.RESULTS: Some 4096 patients were analysed. Pulmonary complications and anastomotic leakage had the greatest overall impact on postoperative mortality (risk-adjusted PAF 44·1 and 30·4 per cent respectively), prolonged hospital stay (risk-adjusted PAF 31·4 and 30·9 per cent) and readmission to hospital (risk-adjusted PAF 7·3 and 14·7 per cent). Anastomotic leakage had the greatest impact on reoperation (risk-adjusted PAF 47·1 per cent). In contrast, the impact of other complications on these outcomes was relatively small.CONCLUSION: Reducing the incidence of pulmonary complications and anastomotic leakage may have the greatest clinical impact on outcomes after oesophagectomy.
KW - Adenocarcinoma/surgery
KW - Aged
KW - Carcinoma, Squamous Cell/surgery
KW - Esophageal Neoplasms/surgery
KW - Esophagectomy/adverse effects
KW - Female
KW - Humans
KW - Length of Stay/statistics & numerical data
KW - Male
KW - Patient Readmission/statistics & numerical data
KW - Postoperative Complications/etiology
KW - Prospective Studies
KW - Reoperation/statistics & numerical data
KW - Risk Factors
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85055697709&partnerID=8YFLogxK
U2 - 10.1002/bjs.11000
DO - 10.1002/bjs.11000
M3 - Article
C2 - 30370938
SN - 0007-1323
VL - 106
SP - 111
EP - 119
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 1
ER -