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

Sander Ubels; Eric Matthée; 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; null TENTACLE – Esophagus Collaborative Group; Joos Heisterkamp; Fatih Polat; Jeroen Schouten; Pritam Singh; Cettela A. M. Slootmans; Gijs Ultee; Suzanne S. Gisbertz; Wietse J. Eshuis; Marianne C. Kalff; Minke L. Feenstra; Donald L. van der Peet; Wessel T. Stam; Boudewijn Van Etten; Floris Poelmann; Nienke Vuurberg; Jan Willem van den Berg; Ingrid S. Martijnse; Robert M. Matthijsen; Misha Luyer; Wout Curvers; Tom Nieuwenhuijzen; Annick E. Taselaar; Ewout A. Kouwenhoven; Merel Lubbers; Meindert Sosef; Frederik Lecot; Tessa C.M. Geraedts; Frits van den Wildenberg; Wendy Kelder; Peter C. Baas; Neil D. Merrett; null et al

doi:10.1016/j.ejso.2023.01.010

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

Sander Ubels, Eric Matthée, 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, TENTACLE – Esophagus Collaborative Group, Joos HeisterkampFatih Polat, Jeroen Schouten, Pritam Singh, Cettela A. M. Slootmans, Gijs Ultee, Suzanne S. Gisbertz, Wietse J. Eshuis, Marianne C. Kalff, Minke L. Feenstra, Donald L. van der Peet, Wessel T. Stam, Boudewijn Van Etten, Floris Poelmann, Nienke Vuurberg, Jan Willem van den Berg, Ingrid S. Martijnse, Robert M. Matthijsen, Misha Luyer, Wout Curvers, Tom Nieuwenhuijzen, Annick E. Taselaar, Ewout A. Kouwenhoven, Merel Lubbers, Meindert Sosef, Frederik Lecot, Tessa C.M. Geraedts, Frits van den Wildenberg, Wendy Kelder, Peter C. Baas, Neil D. Merrett, et al

Western Sydney University

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

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 language	English
Pages (from-to)	974-982
Number of pages	9
Journal	European Journal of Surgical Oncology
Volume	49
Issue number	5
DOIs	https://doi.org/10.1016/j.ejso.2023.01.010
Publication status	Published - May 2023

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© 2023 The Authors

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10.1016/j.ejso.2023.01.010

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Ubels, S., Matthée, E., Verstegen, M., Klarenbeek, B., Bouwense, S., Berge Henegouwen, M. I. V., 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., TENTACLE – Esophagus Collaborative Group, ... et al (2023). Practice variation in anastomotic leak after esophagectomy : unravelling differences in failure to rescue. European Journal of Surgical Oncology, 49(5), 974-982. https://doi.org/10.1016/j.ejso.2023.01.010

@article{9d97b6ddf7354b2b8a19416c5fc7dd2f,

title = "Practice variation in anastomotic leak after esophagectomy : unravelling differences in failure to rescue",

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.",

author = "Sander Ubels and Eric Matth{\'e}e and Moniek Verstegen and Bastiaan Klarenbeek and Stefan Bouwense and {Berge Henegouwen}, {Mark I. van} and Freek Daams and Dekker, {Jan Willem T.} and {van Det}, {Marc J.} and {van Esser}, Stijn and Griffiths, {Ewen A.} and Haveman, {Jan Willem} and Grard Nieuwenhuijzen and Siersema, {Peter D.} and Bas Wijnhoven and Gerjon Hannink and {van Workum}, Frans and Camiel Rosman and {TENTACLE – Esophagus Collaborative Group} and Joos Heisterkamp and Fatih Polat and Jeroen Schouten and Pritam Singh and Slootmans, {Cettela A. M.} and Gijs Ultee and Gisbertz, {Suzanne S.} and Eshuis, {Wietse J.} and Kalff, {Marianne C.} and Feenstra, {Minke L.} and {van der Peet}, {Donald L.} and Stam, {Wessel T.} and {Van Etten}, Boudewijn and Floris Poelmann and Nienke Vuurberg and {van den Berg}, {Jan Willem} and Martijnse, {Ingrid S.} and Matthijsen, {Robert M.} and Misha Luyer and Wout Curvers and Tom Nieuwenhuijzen and Taselaar, {Annick E.} and Kouwenhoven, {Ewout A.} and Merel Lubbers and Meindert Sosef and Frederik Lecot and Geraedts, {Tessa C.M.} and {van den Wildenberg}, Frits and Wendy Kelder and Baas, {Peter C.} and Merrett, {Neil D.} and {et al}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = may,

doi = "10.1016/j.ejso.2023.01.010",

language = "English",

volume = "49",

pages = "974--982",

journal = "European Journal of Surgical Oncology",

issn = "1532-2157",

publisher = "W.B. Saunders Ltd",

number = "5",

}

Ubels, S, Matthée, E, Verstegen, M, Klarenbeek, B, Bouwense, S, Berge Henegouwen, MIV, Daams, F, Dekker, JWT, van Det, MJ, van Esser, S, Griffiths, EA, Haveman, JW, Nieuwenhuijzen, G, Siersema, PD, Wijnhoven, B, Hannink, G, van Workum, F, Rosman, C, TENTACLE – Esophagus Collaborative Group, Heisterkamp, J, Polat, F, Schouten, J, Singh, P, Slootmans, CAM, Ultee, G, Gisbertz, SS, Eshuis, WJ, Kalff, MC, Feenstra, ML, van der Peet, DL, Stam, WT, Van Etten, B, Poelmann, F, Vuurberg, N, van den Berg, JW, Martijnse, IS, Matthijsen, RM, Luyer, M, Curvers, W, Nieuwenhuijzen, T, Taselaar, AE, Kouwenhoven, EA, Lubbers, M, Sosef, M, Lecot, F, Geraedts, TCM, van den Wildenberg, F, Kelder, W, Baas, PC, Merrett, ND & et al 2023, 'Practice variation in anastomotic leak after esophagectomy : unravelling differences in failure to rescue', European Journal of Surgical Oncology, vol. 49, no. 5, pp. 974-982. https://doi.org/10.1016/j.ejso.2023.01.010

TY - JOUR

T1 - Practice variation in anastomotic leak after esophagectomy : unravelling differences in failure to rescue

AU - Ubels, Sander

AU - Matthée, Eric

AU - Verstegen, Moniek

AU - Klarenbeek, Bastiaan

AU - Bouwense, Stefan

AU - Berge Henegouwen, Mark I. van

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 - TENTACLE – Esophagus Collaborative Group, null

AU - Heisterkamp, Joos

AU - Polat, Fatih

AU - Schouten, Jeroen

AU - Singh, Pritam

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 - van den Berg, Jan Willem

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 - Merrett, Neil D.

AU - et al, null

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.

UR - https://hdl.handle.net/1959.7/uws:74104

U2 - 10.1016/j.ejso.2023.01.010

DO - 10.1016/j.ejso.2023.01.010

M3 - Article

SN - 1532-2157

SN - 0748-7983

VL - 49

SP - 974

EP - 982

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 5

ER -

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

Abstract

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