Failure to Rescue from Surgical Complications After Trans-thoracic and Trans-hiatal Esophageal Resection: an ACS-NSQIP S
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RESEARCH COMMUNICATION
Failure to Rescue from Surgical Complications After Trans-thoracic and Trans-hiatal Esophageal Resection: an ACS-NSQIP Study Kenny J. Oh 1 & Csaba Gajdos 1 & Goda E. Savulionyte 1 & Mark Hennon 2 & Steven D. Schwaitzberg 1 & Nader D. Nader 1,3 Received: 31 March 2020 / Accepted: 6 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Cardiovascular events . Complications . Esophagectomy . Pulmonary events . Surgical approach
Introduction There remains a dearth of information regarding the sequelae of complications of esophagectomy, including failure to rescue, i.e., the inability to prevent death after the development of a complication.1, 2 We compared outcomes for THE and TTE, including failure to rescue using the ACS-NSQIP.
ization among patients who experience a complication and was considered the primary outcome variable for our analysis. Univariate analysis was performed comparing demographics and clinical characteristics between the two groups. Multivariable analysis (MVA) was performed analyzing the occurrence of complications and their relation to death within 30 days between THE and TTE. Regression model was constructed for the combined data, in which the surgical approach was forced into the model as an independent variable.
Methods Patients between 2005 and 2015 were identified using CPT codes (43107 and 43117) for THE and TTE (open procedures). Post-operative complications were clustered in the following groups: wound complications (superficial or deep), infections (sepsis, septic shock, mediastinitis, urinary tract infections, SSM), respiratory complications, RC (pneumonia, respiratory failure requiring re-insertion of an endotracheal tube, failure to wean mechanical ventilation), bleeding requiring transfusion, AKI, cerebrovascular accidents, major adverse cardiac events (MACE), and mortality within 30 days. Failure to rescue (FTR) was defined as death during hospital-
Kenny J. Oh and Csaba Gajdos are the first authors. * Nader D. Nader [email protected] 1
Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA
2
Department of Surgery, Roswell Park Cancer Institute, Buffalo, NY 14203, USA
3
Department of Anesthesiology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
Results A total of 6049 patients were included in the final analysis. In total, 3874 underwent TTE, and 2171 underwent THE. Patients undergoing THE were significantly more likely to be female, Hispanic, have dependent functional status, be older, and have pneumonia, cardiac comorbidities, and chronic kidney disease in comparison with those undergoing TTE. On univariate analysis, TTE was associated with significantly higher rates of sepsis, septic shock, mediastinitis, urinary tract infections, MACE, as well as higher superficial and deep wound complications. There was no significant difference in length of hospital stay, overall complication rate, RC, bleeding requiring tra
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