Format

Send to

Choose Destination
See comment in PubMed Commons below
JAMA Surg. 2013 Mar;148(3):272-6. doi: 10.1001/jamasurg.2013.791.

Failure to rescue patients after reintervention in gastroesophageal cancer surgery in England.

Author information

1
Department of Surgery and Cancer, Faculty of Medicine, St Mary’s Hospital.

Abstract

IMPORTANCE:

Gastroesophageal cancer resections are associated with significant reintervention and perioperative mortality rates.

OBJECTIVE:

To compare outcomes following operative and nonoperative reinterventions between high- and low-mortality gastroesophageal cancer surgical units in England.

DESIGN:

All elective esophageal and gastric resections for cancer between 2000 and 2010 in English public hospitals were identified from a national administrative database. Units were divided into low- and high-mortality units (LMUs and HMUs, respectively) using a threshold of 5% or less for 30-day adjusted mortality. The groups were compared for reoperations and nonoperative reinterventions following complications.

SETTING:

Both LMUs and HMUs.

PARTICIPANTS:

Patients who underwent esophageal and gastric resections for cancer.

EXPOSURE:

Elective esophageal and gastric resections for cancer, with reoperations and nonoperative reinterventions following complications.

MAIN OUTCOMES AND MEASURES:

Failure to rescue is defined as the death of a patient following a complication; failure to rescue-surgical is defined as the death of a patient following reoperation for a surgical complication.

RESULTS:

There were 14 955 esophagectomies and 10 671 gastrectomies performed in 141 units. For gastroesophageal resections combined, adjusted mortality rates were 3.0% and 8.3% (P < .001) for LMUs and HMUs, respectively. Complications rates preceding reoperation were similar (5.4% for LMUs vs. 4.9% for HMUs; P = .11). The failure to rescue-surgical rates were lower in LMUs than in HMUs (15.3% vs. 24.1%; P < .001). The LMUs performed more nonoperative reinterventions than the HMUs did (6.7% vs. 4.7%; P < .001), with more patients surviving in LMUs than in HMUs (failure to rescue rate, 7.0% vs. 12.5%; P < .001). Overall, LMUs reintervened more than HMUs did (12.2% vs 9.6%; P < .001), and LMUs had lower failure to rescue rates following reintervention than HMUs did (9.0% vs. 18.3%; P = .001). All P values stated refer to 2-sided values.

CONCLUSIONS AND RELEVANCE:

Overall, LMUs were more likely to reintervene and rescue patients following gastroesophageal cancer resections in England. Patients were more likely to survive following both reoperations and nonsurgical interventions in LMUs.

PMID:
23553312
DOI:
10.1001/jamasurg.2013.791
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Support Center