Department of Surgery and Cancer, Faculty of Medicine, St Mary’s Hospital.
JAMA Surg. 2013 Mar;148(3):272-6. doi: 10.1001/jamasurg.2013.791.
Gastroesophageal cancer resections are associated with significant reintervention and perioperative mortality rates.
To compare outcomes following operative and nonoperative reinterventions between high- and low-mortality gastroesophageal cancer surgical units in England.
All elective esophageal and gastric resections for cancer between 2000 and 2010 in English public hospitals were identified from a national administrative database. Units were divided into low- and high-mortality units (LMUs and HMUs, respectively) using a threshold of 5% or less for 30-day adjusted mortality. The groups were compared for reoperations and nonoperative reinterventions following complications.
Both LMUs and HMUs.
Patients who underwent esophageal and gastric resections for cancer.
Elective esophageal and gastric resections for cancer, with reoperations and nonoperative reinterventions following complications.
Failure to rescue is defined as the death of a patient following a complication; failure to rescue-surgical is defined as the death of a patient following reoperation for a surgical complication.
There were 14 955 esophagectomies and 10 671 gastrectomies performed in 141 units. For gastroesophageal resections combined, adjusted mortality rates were 3.0% and 8.3% (P < .001) for LMUs and HMUs, respectively. Complications rates preceding reoperation were similar (5.4% for LMUs vs. 4.9% for HMUs; P = .11). The failure to rescue-surgical rates were lower in LMUs than in HMUs (15.3% vs. 24.1%; P < .001). The LMUs performed more nonoperative reinterventions than the HMUs did (6.7% vs. 4.7%; P < .001), with more patients surviving in LMUs than in HMUs (failure to rescue rate, 7.0% vs. 12.5%; P < .001). Overall, LMUs reintervened more than HMUs did (12.2% vs 9.6%; P < .001), and LMUs had lower failure to rescue rates following reintervention than HMUs did (9.0% vs. 18.3%; P = .001). All P values stated refer to 2-sided values.
Overall, LMUs were more likely to reintervene and rescue patients following gastroesophageal cancer resections in England. Patients were more likely to survive following both reoperations and nonsurgical interventions in LMUs.
胃食管交界处癌切除术与较高的再干预和围手术期死亡率相关。
比较英国高死亡率和低死亡率胃肠癌手术单位手术和非手术再干预的结果。
从国家行政数据库中确定了 2000 年至 2010 年间英国公立医院所有进行的食管癌和胃癌择期切除术。使用 30 天调整死亡率<5%的阈值将单位分为低死亡率单位（LMU）和高死亡率单位（HMU）。对并发症后再手术和非手术再干预进行比较。
LMU 和 HMU 两者。
接受食管癌和胃癌切除术的患者。
食管癌和胃癌择期切除术，并发症后再手术和非手术再干预。
救援失败定义为患者在并发症后死亡；手术救援失败定义为患者在外科并发症后再手术时死亡。
141 个单位进行了 14955 例食管切除术和 10671 例胃切除术。对于胃食管交界处切除术，LMU 和 HMU 的调整死亡率分别为 3.0%和 8.3%（P<0.001）。手术前并发症发生率相似（LMU 为 5.4%，HMU 为 4.9%；P=0.11）。LMU 的手术救援失败率低于 HMU（15.3%比 24.1%；P<0.001）。LMU 比 HMU 进行更多的非手术再干预（6.7%比 4.7%；P<0.001），LMU 的患者存活率高于 HMU（救援失败率，7.0%比 12.5%；P<0.001）。总体而言，LMU 的再干预次数多于 HMU（12.2%比 9.6%；P<0.001），LMU 的再干预后救援失败率低于 HMU（9.0%比 18.3%；P=0.001）。所有陈述的 P 值均为双侧值。
总体而言，在英国，LMU 更有可能在胃食管交界处癌切除术后进行再干预和挽救患者。LMU 患者在再手术和非手术干预后更有可能存活。
