Research output per year
Research output per year
Sander Ubels*, Eric Matthee, Moniek Verstegen, Bastiaan Klarenbeek, Stefan Bouwense, Mark I. van Berge Henegouwen, Freek Daams, Jan Willem T. Dekker, Marc J. van Det, Stijn van Esser, Ewen A. Griffiths, Jan Willem Haveman, Grard Nieuwenhuijzen, Peter D. Siersema, Bas Wijnhoven, Gerjon Hannink, Frans van Workum, Camiel Rosman, Joos Heisterkamp, Fatih Polat
Research output: Contribution to journal › Article › Academic › peer-review
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.
Original language | English |
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Pages (from-to) | 974-982 |
Number of pages | 9 |
Journal | European Journal of Surgical Oncology |
Volume | 49 |
Issue number | 5 |
DOIs | |
Publication status | Published - 1 May 2023 |
Research output: Contribution to journal › Erratum / corrigendum / retractions › Academic