TY - JOUR
T1 - Practice variation in anastomotic leak after esophagectomy
T2 - Unravelling differences in failure to rescue
AU - Ubels, Sander
AU - Matthée, Eric
AU - Verstegen, Moniek
AU - Klarenbeek, Bastiaan
AU - Bouwense, Stefan
AU - van Berge Henegouwen, Mark I.
AU - Daams, Freek
AU - Dekker, Jan Willem T.
AU - van Det, Marc J.
AU - van Esser, Stijn
AU - Griffiths, Ewen A.
AU - Haveman, Jan Willem
AU - Nieuwenhuijzen, Grard
AU - Siersema, Peter D.
AU - Wijnhoven, Bas
AU - Hannink, Gerjon
AU - van Workum, Frans
AU - Rosman, Camiel
AU - Slootmans, Cettela A. M.
AU - Ultee, Gijs
AU - Gisbertz, Suzanne S.
AU - Eshuis, Wietse J.
AU - Kalff, Marianne C.
AU - Feenstra, Minke L.
AU - van der Peet, Donald L.
AU - Stam, Wessel T.
AU - van Etten, Boudewijn
AU - Poelmann, Floris
AU - Vuurberg, Nienke
AU - Willem van den Berg, Jan
AU - Martijnse, Ingrid S.
AU - Matthijsen, Robert M.
AU - Luyer, Misha
AU - Curvers, Wout
AU - Nieuwenhuijzen, Tom
AU - Taselaar, Annick E.
AU - Kouwenhoven, Ewout A.
AU - Lubbers, Merel
AU - Sosef, Meindert
AU - Lecot, Frederik
AU - Geraedts, Tessa C. M.
AU - van den Wildenberg, Frits
AU - Kelder, Wendy
AU - Baas, Peter C.
AU - de Haas, Job W. A.
AU - Hartgrink, Henk H.
AU - Bahadoer, Renu R.
AU - van Sandick, Johanna W.
AU - Hartemink, Koen J.
AU - Veenhof, Xander
AU - Stockmann, Hein
AU - Gorgec, Burak
AU - Weeder, Pepijn
AU - Wiezer, Marinus J.
AU - Genders, Charlotte M. S.
AU - Belt, Eric
AU - Blomberg, Bjorn
AU - van Duijvendijk, Peter
AU - Claassen, Linda
AU - Reetz, David
AU - Steenvoorde, Pascal
AU - Mastboom, Walter
AU - Klein Ganseij, Henk Jan
AU - van Dalsen, Annette D.
AU - Joldersma, Annalie
AU - Zwakman, Marije
AU - Groenendijk, Richard P. R.
AU - Montazeri, Mahsa
AU - Mercer, Stuart
AU - Knight, Benjamin
AU - van Boxel, Gijs
AU - McGregor, Richard J.
AU - Skipworth, Richard J. E.
AU - Frattini, Cristina
AU - Bradley, Alice
AU - Nilsson, Magnus
AU - Hayami, Masaru
AU - Huang, Biying
AU - Bundred, James
AU - Evans, Richard
AU - Grimminger, Peter P.
AU - van der Sluis, Pieter C.
AU - Eren, Uzun
AU - Saunders, John
AU - Theophilidou, Elena
AU - Khanzada, Zubair
AU - Elliott, Jessie A.
AU - Ponten, Jeroen
AU - King, Sinead
AU - Reynolds, John V.
AU - Sgromo, Bruno
AU - Akbari, Khalid
AU - Shalaby, Samar
AU - Gutschow, Christian A.
AU - Schmidt, Henner
AU - Vetter, Diana
AU - Moorthy, Krishna
AU - Ibrahim, Mohamed A. H.
AU - Christodoulidis, Grigorious
AU - Räsänen, Jari V.
AU - Kauppi, Juha
AU - Söderström, Henna
AU - Koshy, Renol
AU - Manatakis, Dimitrios K.
AU - Korkolis, Dimitrios P.
AU - Balalis, Dimitrios
AU - Rompu, Aliki
AU - Alkhaffaf, Bilal
AU - Alasmar, Mohamed
AU - Arebi, Moaad
AU - Piessen, Guillaume
AU - Nuytens, Frederiek
AU - Degisors, Sebastien
AU - Ahmed, Ahmed
AU - Boddy, Alex
AU - Gandhi, Suraj
AU - Fashina, Oluwatomini
AU - van Daele, Elke
AU - Pattyn, Piet
AU - Robb, William B.
AU - Arumugasamy, Mayilone
AU - Al Azzawi, Mohammed
AU - Whooley, Jack
AU - Colak, Elif
AU - Aybar, Engin
AU - Sari, Ahmet C.
AU - Uyanik, Mustafa S.
AU - Ciftci, Ahmet B.
AU - Sayyed, Raza
AU - Ayub, Bushra
AU - Murtaza, Ghulam
AU - Saeed, Aniqa
AU - Ramesh, Priyanka
AU - Charalabopoulos, Alexandros
AU - Liakakos, Theodore
AU - Schizas, Dimitrios
AU - Baili, Efstratia
AU - Kapelouzou, Alkistis
AU - Valmasoni, Michele
AU - Pierobon, Elisa Sefora
AU - Capovilla, Giovanni
AU - Merigliano, Stefano
AU - Constantinoiu, Silviu
AU - Birla, Rodica
AU - Achim, Florin
AU - Rosianu, Cristian Gelu
AU - Hoara, Petre
AU - Castro, Raúl Guevara
AU - Salcedo, Andrés Felipe
AU - Negoi, Ionut
AU - Negoita, Valentina M.
AU - Ciubotaru, Cezar
AU - Stoica, Bogdan
AU - Hostiuc, Sorin
AU - Colucci, Nicola
AU - Mönig, Stefan P.
AU - Wassmer, Charles-Henri
AU - Meyer, Jeremy
AU - Takeda, Flavio Roberto
AU - Aissar Sallum, Rubens Antonio
AU - Ribeiro, Ulysses
AU - Cecconello, Ivan
AU - Toledo, Enrique
AU - Trugeda, Maria Soledad
AU - Fernández, María José
AU - Gil, Carolina
AU - Castanedo, Sonia
AU - Isik, Arda
AU - Kurnaz, Eray
AU - Videira, José Flávio
AU - Peyroteo, Mariana
AU - Canotilho, Rita
AU - Weindelmayer, Jacopo
AU - Giacopuzzi, Simone
AU - de Pasqual, Carlo Alberto
AU - Bruna, Marcos
AU - Mingol, Fernando
AU - Vaque, Javier
AU - Pérez, Carla
AU - Phillips, Alexander W.
AU - Chmelo, Jakub
AU - Brown, Joshua
AU - Han, Laura E.
AU - Gossage, James A.
AU - Davies, Andrew R.
AU - Baker, Cara R.
AU - Kelly, Mark
AU - Saad, Mohamed
AU - Bernardi, Daniele
AU - Bonavina, Luigi
AU - Asti, Emanuele
AU - Riva, Carlo
AU - Scaramuzzo, Rosa
AU - Elhadi, Muhammed
AU - study collaborators
AU - Ahmed, Hazem Abdelkarem
AU - Elhadi, Ahmed
AU - Elnagar, Faruk Ali
AU - Msherghi, Ahmed A. A.
AU - Wills, Vanessa
AU - Campbell, Cassidy
AU - Cerdeira, Marisol Perez
AU - Whiting, Scott
AU - Merrett, Neil
AU - Das, Amitabha
AU - Apostolou, Christos
AU - Lorenzo, Aldenb
AU - Sousa, Fabiana
AU - Barbosa, José Adelino
AU - Devezas, V. tor
AU - Barbosa, Elisabete
AU - Fernandes, Cristina
AU - Smith, Garett
AU - Li, Edward Y.
AU - Bhimani, Nazim
AU - Chan, Priscilla
AU - Kotecha, Krishna
AU - Hii, Michael W.
AU - Ward, Salena M.
AU - Johnson, MaryAnn
AU - Read, Matthew
AU - Chong, Lynn
AU - Hollands, Michael J.
AU - Allaway, Matthew
AU - Richardson, Arthur
AU - Johnston, Emma
AU - Chen, Andy Z. L.
AU - Kanhere, Harsh
AU - Prasad, Shalvin
AU - McQuillan, Patrick
AU - Surman, Tim
AU - Trochsler, MarkusI.
AU - Schofield, W. A.
AU - Ahmed, Syeda Khadijah
AU - Reid, Jessica L.
AU - Harris, Mark C.
AU - Gananadha, Sivakumar
AU - Farrant, Jessica
AU - Rodrigues, Nicole
AU - Fergusson, James
AU - Hindmarsh, Andrew
AU - Afzal, Zeeshan
AU - Safranek, Peter
AU - Sujendran, Vijay
AU - Rooney, Siobhan
AU - Loureiro, Carlos
AU - Fernández, Saioa Leturio
AU - Díez del Val, Ismael
AU - Jaunoo, Shameen
AU - Kennedy, Lauren
AU - Hussain, Ahmed
AU - the TENTACLE – Esophagus collaborative group
AU - Theodorou, Dimitrios
AU - Triantafyllou, Tania
AU - Theodoropoulos, Charalampos
AU - Palyvou, Theodora
AU - Ben Taher, Fatima Abdullah
AU - Ekheel, Mustafa
AU - Heisterkamp, Joos
AU - Polat, Fatih
AU - Schouten, Jeroen
AU - Singh, Pritam
N1 - Funding Information:
The TENTACLE – Esophagus study received funding from Medtronic company. The study was performed independently, and Medtronic had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit to manuscript.
Publisher Copyright:
© 2023 The Authors
PY - 2023/5
Y1 - 2023/5
N2 - 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.
AB - 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.
KW - Anastomotic leak
KW - Complications
KW - Esophagectomy
KW - Failure to rescue
KW - Practice variation
UR - https://www.scopus.com/pages/publications/85149737025
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85149737025&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36732207
U2 - 10.1016/j.ejso.2023.01.010
DO - 10.1016/j.ejso.2023.01.010
M3 - Article
C2 - 36732207
SN - 0748-7983
VL - 49
SP - 974
EP - 982
JO - European journal of surgical oncology
JF - European journal of surgical oncology
IS - 5
ER -