دورية أكاديمية
أعرض في EDS

Understanding Failure to Rescue After Esophagectomy in the United States.

التفاصيل البيبلوغرافية
العنوان: Understanding Failure to Rescue After Esophagectomy in the United States.
المؤلفون: Abdelsattar ZM; Department of Surgery, Mayo Clinic, Rochester, Minnesota., Habermann E; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota., Borah BJ; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota., Moriarty JP; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota., Rojas RL; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota., Blackmon SH; Department of Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: blackmon.shanda@mayo.edu.
المصدر: The Annals of thoracic surgery [Ann Thorac Surg] 2020 Mar; Vol. 109 (3), pp. 865-871. Date of Electronic Publication: 2019 Nov 09.
نوع المنشور: Journal Article; Multicenter Study
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 15030100R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6259 (Electronic) Linking ISSN: 00034975 NLM ISO Abbreviation: Ann Thorac Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: Amsterdam : Elsevier
Original Publication: Boston.
مواضيع طبية MeSH: Quality Improvement*, Esophageal Neoplasms/*surgery , Esophagectomy/*adverse effects , Failure to Rescue, Health Care/*statistics & numerical data , Postoperative Complications/*epidemiology, Aged ; Databases, Factual ; Esophageal Neoplasms/mortality ; Female ; Hospital Mortality/trends ; Hospitalization/statistics & numerical data ; Humans ; Incidence ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; United States/epidemiology
مستخلص: Background: Data on failure to rescue (FTR) after esophagectomy are sparse. We sought to better understand the patient factors associated with FTR and to assess whether FTR is associated with hospital volume.
Methods: We identified all patients undergoing esophagectomy between 2010 and 2014 from the Agency for Healthcare Research and Quality Nationwide Readmission Database. We defined FTR as mortality after a major complication. Multiple logistic regression was used to identify patient factors and hospital-volume associations with FTR.
Results: Of 26,820 patients undergoing an esophagectomy, 7130 (26.6%) experienced a major complication. Of those, 1321 did not survive the index hospitalization (FTR rate, 18.5%). Risk factors for FTR included increasing age (adjusted odds ratio [aOR], 1.06; P < .001), congestive heart failure (aOR, 2.07; P < .001), bleeding disorders (aOR, 2.9; P < .001), liver disease (aOR, 2.37; P = .001), and renal failure (aOR, 2.37; P = .002). At the hospital level there was wide variation in FTR rates across hospital volume quintiles, with 21.2% of patients suffering a complication not surviving to discharge at low-volume hospitals compared with 13.4% at high-volume hospitals (P < .001). At low-volume hospitals the highest FTR rates were acute renal failure (35.3%), postoperative hemorrhage (31.9%), and pulmonary failure (28.1%).
Conclusions: One in 5 esophagectomy patients suffering a complication at low-volume hospitals do not survive to discharge. Several patient factors are associated with death after a major complication. Strategies to improve the recognition and management of complications in at-risk patients may be essential to improve outcomes at low-volume hospitals.
(Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
التعليقات: Comment in: Ann Thorac Surg. 2020 Mar;109(3):871-872. (PMID: 31862497)
تواريخ الأحداث: Date Created: 20191111 Date Completed: 20200507 Latest Revision: 20200507
رمز التحديث: 20240829
DOI: 10.1016/j.athoracsur.2019.09.044
PMID: 31706867
قاعدة البيانات: MEDLINE
الوصف
تدمد:1552-6259
DOI:10.1016/j.athoracsur.2019.09.044