Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue

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 PolatJeroen Schouten, Pritam Singh, TENTACLE-Esophagus Collaborative Group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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 languageEnglish
Pages (from-to)974-982
Number of pages9
JournalEuropean Journal of Surgical Oncology
Volume49
Issue number5
DOIs
Publication statusPublished - 1 May 2023

Keywords

  • Failure to rescue
  • Esophagectomy
  • Complications
  • Anastomotic leak
  • Practice variation
  • HOSPITAL VOLUME
  • POSTOPERATIVE MORTALITY
  • CANCER-SURGERY
  • 30-DAY
  • COMPLICATIONS
  • 90-DAY

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  • Erratum to “Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue (vol 49, pg 974, 2023)

    Ubels, S., Matthée, E., Verstegen, M., Klarenbeek, B., Bouwense, S., van Berge Henegouwen, M. I., Daams, F., Dekker, J. W. T., van Det, M. J., van Esser, S., Griffiths, E. A., Haveman, J. W., Nieuwenhuijzen, G., Siersema, P. D., Wijnhoven, B., Hannink, G., van Workum, F., Rosman, C., Heisterkamp, J. & Polat, F. & 31 others, Schouten, J., Singh, P., Slootmans, C. A. M., Ultee, G., Gisbertz, S. S., Eshuis, W. J., Kalff, M. C., Feenstra, M. L., van der Peet, D. L., Stam, W. T., Van Etten, B., Poelmann, F., Vuurberg, N., Willem van den Berg, J., Martijnse, I. S., Matthijsen, R. M., Luyer, M., Curvers, W., Nieuwenhuijzen, T., Taselaar, A. E., Kouwenhoven, E. A., Lubbers, M., Sosef, M., Lecot, F., Geraedts, T. C. M., van den Wildenberg, F., Kelder, W., Baas, P. C., de Haas, J. W. A., Hartgrink, H. H. & TENTACLE-Esophagus Collaborative Group, 1 Sept 2023, In: European Journal of Surgical Oncology. 49, 9, 1 p., 106993.

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