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

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Citações na Scopus
2
Tipo de produção
article
Data de publicação
2023
DOI
Scopus
Web of Science
PubMed
Dimensions
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCI LTD
Autores
UBELS, Sander
MATTHEE, Eric
VERSTEGEN, Moniek
KLARENBEEK, Bastiaan
BOUWENSE, Stefan
HENEGOUWEN, Mark I. van Berge
DAAMS, Freek
DEKKER, Jan Willem T.
DET, Marc J. van
ESSER, Stijn van
Citação
EJSO, v.49, n.5, p.974-982, 2023
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Introduction: 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.
Palavras-chave
Failure to rescue, Esophagectomy, Complications, Anastomotic leak, Practice variation
URI
https://observatorio.fm.usp.br/handle/OPI/58880
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MGT