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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.
Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue
Ubels S.;Matthee 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.;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.;Bahadoer R. R.;van Sandick J. W.;Hartemink K. J.;Veenhof X.;Stockmann H.;Gorgec B.;Weeder P.;Wiezer M. J.;Genders C. M. S.;Belt E.;Blomberg B.;van Duijvendijk P.;Claassen L.;Reetz D.;Steenvoorde P.;Mastboom W.;Klein Ganseij H. J.;van Dalsen A. D.;Joldersma A.;Zwakman M.;Groenendijk R. P. R.;Montazeri M.;Mercer S.;Knight B.;van Boxel G.;McGregor R. J.;Skipworth R. J. E.;Frattini C.;Bradley A.;Nilsson M.;Hayami M.;Huang B.;Bundred J.;Evans R.;Grimminger P. P.;van der Sluis P. C.;Eren U.;Saunders J.;Theophilidou E.;Khanzada Z.;Elliott J. A.;Ponten J.;King S.;Reynolds J. V.;Sgromo B.;Akbari K.;Shalaby S.;Gutschow C. A.;Schmidt H.;Vetter D.;Moorthy K.;Ibrahim M. A. H.;Christodoulidis G.;Rasanen J. V.;Kauppi J.;Soderstrom H.;Koshy R.;Manatakis D. K.;Korkolis D. P.;Balalis D.;Rompu A.;Alkhaffaf B.;Alasmar M.;Arebi M.;Piessen G.;Nuytens F.;Degisors S.;Ahmed A.;Boddy A.;Gandhi S.;Fashina O.;Van Daele E.;Pattyn P.;Robb W. B.;Arumugasamy M.;Al Azzawi M.;Whooley J.;Colak E.;Aybar E.;Sari A. C.;Uyanik M. S.;Ciftci A. B.;Sayyed R.;Ayub B.;Murtaza G.;Saeed A.;Ramesh P.;Charalabopoulos A.;Liakakos T.;Schizas D.;Baili E.;Kapelouzou A.;Valmasoni M.;Pierobon E. S.;Capovilla G.;Merigliano S.;Constantinoiu S.;Birla R.;Achim F.;Rosianu C. G.;Hoara P.;Castro R. G.;Salcedo A. F.;Negoi I.;Negoita V. M.;Ciubotaru C.;Stoica B.;Hostiuc S.;Colucci N.;Monig S. P.;Wassmer C. -H.;Meyer J.;Takeda F. R.;Aissar Sallum R. A.;Ribeiro U.;Cecconello I.;Toledo E.;Trugeda M. S.;Fernandez M. J.;Gil C.;Castanedo S.;Isik A.;Kurnaz E.;Videira J. F.;Peyroteo M.;Canotilho R.;Weindelmayer J.;Giacopuzzi S.;De Pasqual C. A.;Bruna M.;Mingol F.;Vaque J.;Perez C.;Phillips A. W.;Chmelo J.;Brown J.;Han L. E.;Gossage J. A.;Davies A. R.;Baker C. R.;Kelly M.;Saad M.;Bernardi D.;Bonavina L.;Asti E.;Riva C.;Scaramuzzo R.;Elhadi M.;Ahmed H. A.;Elhadi A.;Elnagar F. A.;Msherghi A. A. A.;Wills V.;Campbell C.;Cerdeira M. P.;Whiting S.;Merrett N.;Das A.;Apostolou C.;Lorenzo A.;Sousa F.;Barbosa J. A.;Devezas V.;Barbosa E.;Fernandes C.;Smith G.;Li E. Y.;Bhimani N.;Chan P.;Kotecha K.;Hii M. W.;Ward S. M.;Johnson M.;Read M.;Chong L.;Hollands M. J.;Allaway M.;Richardson A.;Johnston E.;Chen A. Z. L.;Kanhere H.;Prasad S.;McQuillan P.;Surman T.;Trochsler M.;Schofield W. A.;Ahmed S. K.;Reid J. L.;Harris M. C.;Gananadha S.;Farrant J.;Rodrigues N.;Fergusson J.;Hindmarsh A.;Afzal Z.;Safranek P.;Sujendran V.;Rooney S.;Loureiro C.;Fernandez S. L.;Diez del Val I.;Jaunoo S.;Kennedy L.;Hussain A.;Theodorou D.;Triantafyllou T.;Theodoropoulos C.;Palyvou T.;Ben Taher F. A.;Ekheel M.;Heisterkamp J.;Polat F.;Schouten J.;Singh P.
2023
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.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/3503703
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.