Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorUBELS, Sander
dc.contributor.authorMATTHEE, Eric
dc.contributor.authorVERSTEGEN, Moniek
dc.contributor.authorKLARENBEEK, Bastiaan
dc.contributor.authorBOUWENSE, Stefan
dc.contributor.authorHENEGOUWEN, Mark I. van Berge
dc.contributor.authorDAAMS, Freek
dc.contributor.authorDEKKER, Jan Willem T.
dc.contributor.authorDET, Marc J. van
dc.contributor.authorESSER, Stijn van
dc.contributor.authorGRIFFITHS, Ewen A.
dc.contributor.authorHAVEMAN, Jan Willem
dc.contributor.authorNIEUWENHUIJZEN, Grard
dc.contributor.authorSIERSEMA, Peter D.
dc.contributor.authorWIJNHOVEN, Bas
dc.contributor.authorHANNINK, Gerjon
dc.contributor.authorWORKUM, Frans van
dc.contributor.authorROSMAN, Camiel
dc.contributor.authorHEISTERKAMP, Joos
dc.contributor.authorPOLAT, Fatih
dc.contributor.authorSCHOUTEN, Jeroen
dc.contributor.authorSINGH, Pritam
dc.contributor.groupauthorTENTACLE-Esophagus Collaborative
dc.contributor.groupauthorTAKEDA, Flavio Roberto
dc.contributor.groupauthorSALLUM, Rubens Antonio Aissar
dc.contributor.groupauthorRIBEIRO, Ulysses
dc.contributor.groupauthorCECCONELLO, Ivan
dc.date.accessioned2024-04-05T19:31:40Z
dc.date.available2024-04-05T19:31:40Z
dc.date.issued2023
dc.description.abstractIntroduction: Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main contributor to FTR. This study aimed to assess differences in FTR after AL between centers, and to identify factors that explain these differences.Methods: TENTACLE -Esophagus is a multicenter, retrospective cohort study, which included 1509 patients with AL after esophagectomy. Differences in FTR were assessed between low-volume (<20 re-sections), middle-volume (20-60 resections) and high-volume centers (>= 60 resections). Mediation analysis was performed using logistic regression, including possible mediators for FTR: case-mix, hos -pital resources, leak severity and treatment. Results: FTR after AL was 11.7%. After adjustment for confounders, FTR was lower in high-volume vs. low-volume (OR 0.44, 95%CI 0.2-0.8), but not versus middle-volume centers (OR 0.67, 95%CI 0.5-1.0). After mediation analysis, differences in FTR were found to be explained by lower leak severity, lower secondary ICU readmission rate and higher availability of therapeutic modalities in high-volume centers. No statistically significant direct effect of hospital volume was found: high-volume vs. low-volume 0.86 (95%CI 0.4-1.7), high-volume vs. middle-volume OR 0.86 (95%CI 0.5-1.4).Conclusion: Lower FTR in high-volume compared with low-volume centers was explained by lower leak severity, less secondary ICU readmissions and higher availability of therapeutic modalities. To reduce FTR after AL, future studies should investigate effective strategies to reduce leak severity and prevent sec-ondary ICU readmission.(c) 2023 The Authors.eng
dc.description.indexMEDLINE
dc.description.indexPubMed
dc.description.indexScopus
dc.description.indexDimensions
dc.description.indexWoS
dc.description.sponsorshipMedtronic company
dc.identifier.citationEJSO, v.49, n.5, p.974-982, 2023
dc.identifier.doi10.1016/j.ejso.2023.01.010
dc.identifier.eissn1532-2157
dc.identifier.issn0748-7983
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/58880
dc.language.isoeng
dc.publisherELSEVIER SCI LTDeng
dc.relation.ispartofEjso
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright ELSEVIER SCI LTDeng
dc.subjectFailure to rescueeng
dc.subjectEsophagectomyeng
dc.subjectComplicationseng
dc.subjectAnastomotic leakeng
dc.subjectPractice variationeng
dc.subject.otherhospital volumeeng
dc.subject.otherpostoperative mortalityeng
dc.subject.othercancer-surgeryeng
dc.subject.other30-dayeng
dc.subject.othercomplicationseng
dc.subject.other90-dayeng
dc.subject.wosOncologyeng
dc.subject.wosSurgeryeng
dc.titlePractice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescueeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryHolanda
hcfmusp.affiliation.countryInglaterra
hcfmusp.affiliation.countryisonl
hcfmusp.affiliation.countryisogb
hcfmusp.author.externalUBELS, Sander:Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Surg, Med Ctr, Nijmegen, Netherlands; Radboud Univ Nijmegen, Med Ctr, POB 9101, NL-6500 HB Nijmegen, Netherlands
hcfmusp.author.externalMATTHEE, Eric:Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Surg, Med Ctr, Nijmegen, Netherlands; Canisius Wilhelmina Hosp, Dept Surg, Nijmegen, Netherlands
hcfmusp.author.externalVERSTEGEN, Moniek:Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Surg, Med Ctr, Nijmegen, Netherlands
hcfmusp.author.externalKLARENBEEK, Bastiaan:Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Surg, Med Ctr, Nijmegen, Netherlands
hcfmusp.author.externalBOUWENSE, Stefan:Maastricht Univ, Dept Surg, Med Ctr, Maastricht, Netherlands
hcfmusp.author.externalHENEGOUWEN, Mark I. van Berge:Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands; Canc Ctr Amsterdam, Amsterdam, Netherlands
hcfmusp.author.externalDAAMS, Freek:Locat Vrije Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
hcfmusp.author.externalDEKKER, Jan Willem T.:Reinier Graaf Gasthuis, Dept Surg, Delft, Netherlands
hcfmusp.author.externalDET, Marc J. van:ZGT Hosp Grp, Dept Surg, Almelo, Netherlands
hcfmusp.author.externalESSER, Stijn van:Reinier Graaf Gasthuis, Dept Surg, Delft, Netherlands
hcfmusp.author.externalGRIFFITHS, Ewen A.:Univ Hosp Birmingham NHS Fdn Trust, Queen Elizabeth Hosp Birmingham, Dept Upper Gastrointestinal Surg, Birmingham, England
hcfmusp.author.externalHAVEMAN, Jan Willem:Univ Med Ctr Groningen, Univ Groningen, Dept Surg, Groningen, Netherlands
hcfmusp.author.externalNIEUWENHUIJZEN, Grard:Catharina Hosp, Dept Surg, Eindhoven, Netherlands
hcfmusp.author.externalSIERSEMA, Peter D.:Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Gastroenterol & Hepatol, Med Ctr, Nijmegen, Netherlands
hcfmusp.author.externalWIJNHOVEN, Bas:Erasmus Univ, Dept Surg, Med Ctr, Rotterdam, Netherlands
hcfmusp.author.externalHANNINK, Gerjon:Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Operating Rooms, Med Ctr, Nijmegen, Netherlands
hcfmusp.author.externalWORKUM, Frans van:Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Surg, Med Ctr, Nijmegen, Netherlands; Canisius Wilhelmina Hosp, Dept Surg, Nijmegen, Netherlands
hcfmusp.author.externalROSMAN, Camiel:Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Surg, Med Ctr, Nijmegen, Netherlands
hcfmusp.author.externalHEISTERKAMP, Joos:Elisabeth Tweesteden Ziekenhuis, Tilburg, Netherlands
hcfmusp.author.externalPOLAT, Fatih:Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
hcfmusp.author.externalSCHOUTEN, Jeroen:Radboud Univ Nijmegen, Med Ctr, POB 9101, NL-6500 HB Nijmegen, Netherlands
hcfmusp.author.externalSINGH, Pritam:Nottingham Univ Hosp NHS Trust, Nottingham, England
hcfmusp.citation.scopus4
hcfmusp.description.beginpage974
hcfmusp.description.endpage982
hcfmusp.description.issue5
hcfmusp.description.volume49
hcfmusp.origemWOS
hcfmusp.origem.dimensionspub.1154685312
hcfmusp.origem.pubmed36732207
hcfmusp.origem.scopus2-s2.0-85149737025
hcfmusp.origem.wosWOS:000989619200001
hcfmusp.publisher.cityOXFORDeng
hcfmusp.publisher.countryENGLANDeng
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