Arlow Renee L, Moore Dirk F, Chen Chunxia, Langenfeld John, August David A
Department of Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, New Jersey 08903-2601 USA.
Department of Biostatistics, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, New Jersey 08903-2601 USA.
Ann Surg Innov Res. 2014 Dec 19;8(1):9. doi: 10.1186/s13022-014-0009-3. eCollection 2014.
The objective of this study is to describe the system and technical factors that enabled our moderate size transhiatal esophagectomy program to achieve low mortality rates.
A retrospective chart review was conducted on 200 consecutive patients who underwent transhiatal esophagectomy at Robert Wood Johnson University Hospital. Primary outcomes included operative times, estimated blood loss, frequency and nature of complications, and lengths of stay in the hospital and the intensive care unit.
In general, surgical outcomes tended to improve over the course of this study. We identified decreased operative time, intra-operative blood loss, frequency of complications, and lengths of intensive care unit and hospital stay as the program matured. Through coordinated actions of the surgical and anesthesia teams, all intraoperative injuries were responded to in an effective, emergent fashion and all but one patient was saved. This resulted in an inhospital and 30-day mortality rate of only 0.5%.
Our study suggests that a dual attending approach, focus on avoiding "failure to rescue", increased volume, and a surgeon driven commitment to quality improvement may lead to low mortality rates after transhiatal esophagectomy.
本研究的目的是描述使我们中等规模的经胸食管切除术项目实现低死亡率的系统和技术因素。
对在罗伯特·伍德·约翰逊大学医院接受经胸食管切除术的200例连续患者进行回顾性病历审查。主要结果包括手术时间、估计失血量、并发症的频率和性质，以及住院时间和重症监护病房的住院时间。
总体而言，在本研究过程中手术结果趋于改善。随着项目的成熟，我们发现手术时间、术中失血量、并发症频率以及重症监护病房和住院时间均有所减少。通过手术和麻醉团队的协同行动，所有术中损伤均得到有效、紧急的处理，除一名患者外所有患者均获救。这导致住院死亡率和30天死亡率仅为0.5%。
我们的研究表明，双重主治医生方法、注重避免“未能挽救”、增加手术量以及外科医生对质量改进的坚定承诺可能导致经胸食管切除术后的低死亡率。
