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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue
European Journal of Surgical Oncology, Volume 49, No. 5, Year 2023
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Description
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 resections), 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, hospital 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 secondary ICU readmission. © 2023 The Authors
Authors & Co-Authors
Bouwense, Stefan A.W.
Netherlands, Maastricht
Maastricht Universitair Medisch Centrum+
van Berge Henegouwen, Mark I.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Netherlands, Amsterdam
Cancer Center Amsterdam
Griffiths, Ewen A.
United Kingdom, Birmingham
University Hospitals Birmingham Nhs Foundation Trust
Siersema, Peter D.
Netherlands, Nijmegen
Radboud Universiteit
Wijnhoven, Bas P.L.
Netherlands, Rotterdam
Erasmus Mc
Hannink, Gerjon
Netherlands, Nijmegen
Radboud Universiteit
Rosman, Camiel
Netherlands, Nijmegen
Radboud Universiteit
Gisbertz, Suzanne S.
Netherlands, Amsterdam
Cancer Center Amsterdam
Luyer, Misha D.P.(Misha)
Netherlands, Eindhoven
Catharina Ziekenhuis
Görgec, Burak
Unknown Affiliation
Wiezer, Marinus J.
Netherlands, Nieuwegein
St. Antonius Ziekenhuis
Nilsson, Magnus
Sweden, Stockholm
Karolinska Universitetssjukhuset
Bundred, James R.
United Kingdom, Birmingham
Queen Elizabeth Hospital Birmingham
Evans, Richard P.T.
United Kingdom, Birmingham
Queen Elizabeth Hospital Birmingham
Reynolds, John Vincent
Unknown Affiliation
Sgromo, Bruno
United Kingdom, Oxford
Oxford University Hospitals Nhs Foundation Trust
Vetter, Diana
Switzerland, Zurich
Universitatsspital Zurich
Moorthy, Krishna M.
United Kingdom, London
Imperial College London
Räsänen, Jari V.
Finland, Helsinki
Helsingin Yliopisto
Koshy, Renol Mathew
United Kingdom, Newcastle
Royal Victoria Infirmary
Manatakis, Dimitrios K.
Greece, Athens
Saint Savvas Hospital
Korkolis, Dimitrios P.
Greece, Athens
Saint Savvas Hospital
Balalis, Dimitrios
Greece, Athens
Saint Savvas Hospital
Alkhaffaf, Bilal
United Kingdom, Salford
Salford Royal Nhs Foundation Trust
Piessen, Guillaume
France, Lille
Chu Lille
Ahmed, Ahmed Rashid
United Kingdom, Leicester
University of Leicester
Boddy, Alexander P.
United Kingdom, Leicester
University of Leicester
Gandhi, Suraj M.
United Kingdom, Leicester
University of Leicester
Robb, William B.
Ireland, Dublin
Beaumont Hospital
Çolak, Elif F.
Turkey, Samsun
Samsun Training and Research Hospital
Sayyed, Raza Hasnain
Pakistan, Karachi
Patel Hospital
Murtaza, Ghulam
Pakistan, Karachi
Patel Hospital
Charalabopoulos, Alexandros
Greece, Athens
Laikon General Hospital
Liakakos, Theodore D.
Greece, Athens
Laikon General Hospital
Schizas, Dimitrios N.
Greece, Athens
Laikon General Hospital
Baili, Efstratia
Greece, Athens
Laikon General Hospital
Valmasoni, Michele
Italy, Padua
Azienda Ospedale Università Padova
Castro, Raúl Guevara
Unknown Affiliation
Negoi, Ionut
Romania, Bucharest
Universitatea de Medicina si Farmacie Carol Davila Din Bucuresti
Negoita, Valentina Madalina
Romania, Bucharest
Universitatea de Medicina si Farmacie Carol Davila Din Bucuresti
Ciubotaru, Cezar I.
Romania, Bucharest
Universitatea de Medicina si Farmacie Carol Davila Din Bucuresti
Hostiuc, Sorin
Romania, Bucharest
Universitatea de Medicina si Farmacie Carol Davila Din Bucuresti
Takeda, Flavio Roberto
Brazil, Sao Paulo
Universidade de São Paulo
Cecconello, Ivan
Brazil, Sao Paulo
Universidade de São Paulo
Toledo-Martínez, Enrique
Spain, Santander
Hospital Universitario Marqués de Valdecilla
Isik, Arda A.
Turkey, Erzincan
Erzincan Binali Yıldırım Üniversitesi
Peyroteo, Mariana
Portugal, Porto
Instituto Português de Oncologia do Porto fg
Weindelmayer, Jacopo
Italy, Verona
Azienda Ospedaliera Universitaria Integrata Verona
Gossage, James A.
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
Davies, Andrew R.
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
Baker, Cara R.
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
Kelly, Mark
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
Bonavina, Luigi
Italy, Milan
Università Degli Studi Di Milano
Scaramuzzo, Rosa
Italy, Milan
Università Degli Studi Di Milano
Elhadi, Muhammed K.
Libya, Tripoli
University of Tripoli
Libya, Sabratha
National Cancer Institute
Elhadi, Ahmed
Libya, Tripoli
University of Tripoli
Msherghi, Ahmed
Libya, Tripoli
University of Tripoli
Libya, Sabratha
National Cancer Institute
Wills, Vanessa Lee
Unknown Affiliation
Cerdeira, Marisol Perez
Unknown Affiliation
Merrett, Neil D.
Australia, Liverpool
South Western Sydney Local Health District
Apostolou, Christos
Australia, Liverpool
South Western Sydney Local Health District
Barbosa, José Adelino Lobarinhas
Portugal, Porto
Centro Hospitalar Universitário de São João
Hii, Michael Wei J.
Australia, Fitzroy
St. Vincent's Hospital Melbourne
Ward, Salena M.
Australia, Fitzroy
St. Vincent's Hospital Melbourne
Johnson, Mary Ann
Australia, Fitzroy
St. Vincent's Hospital Melbourne
Read, Matthew D.
Australia, Fitzroy
St. Vincent's Hospital Melbourne
Richardson, Arthur James
Australia, Sydney
Westmead Hospital
McQuillan, Patrick W.
Australia, Adelaide
Royal Adelaide Hospital
Gananadha, Sivakumar
Australia, Canberra
Canberra Hospital
Fergusson, James
Australia, Canberra
Canberra Hospital
Loureiro, Carlos Manoel Bulcão
Spain, Bilbao
Osakidetza, Basurto University Hospital
Díez-del Val, Ismael
Spain, Bilbao
Osakidetza, Basurto University Hospital
Theodorou, Dimitrios A.
Greece, Athens
Hippokration General Hospital
Heisterkamp, Joos
Unknown Affiliation
Schouten, Jeroen A.
Netherlands, Nijmegen
Radboud University Medical Center
Singh, Pritam
United Kingdom, Nottingham
Nottingham University Hospitals Nhs Trust
Statistics
Citations: 2
Authors: 76
Affiliations: 66
Identifiers
Doi:
10.1016/j.ejso.2023.01.010
ISSN:
07487983
Research Areas
Health System And Policy
Study Design
Cohort Study
Study Approach
Quantitative