Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
Department of Surgery, Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Ann Thorac Surg. 2018 Mar;105(3):871-878. doi: 10.1016/j.athoracsur.2017.10.022. Epub 2018 Feb 2.
Failure to rescue (FTR), defined as death after a major complication, is a metric increasingly being used to assess quality of care. Risk factors associated with FTR after esophagectomy have not been previously studied.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent esophagectomy with gastric conduit between 2010 and 2014. Patients with at least one major postoperative complication were grouped according to inhospital mortality (FTR group) and survival to discharge (SUR group). A stepwise logistic regression model was used to identify predictors of FTR.
A total of 1,730 patients comprised the study group, with 102 (5.9%) in the FTR group and 1,628 (94.1%) in the SUR group. The FTR patients were older (69.0 versus 64.0 years, p < 0.0001) compared with the SUR patients. There were no differences in sex, body mass index, preoperative weight loss, smoking status, operation type, or surgeon specialty between the two groups. Age greater than 75 years (adjusted odds ratio 2.68, p < 0.0001), black race (adjusted odds ratio 2.75, p = 0.001), American Society of Anesthesiologists class 4 or 5 (adjusted odds ratio 1.82, p = 0.02), and the occurrence of pneumonia, respiratory failure, acute renal failure, sepsis, or acute myocardial infarction were predictive of FTR based on multivariable logistic regression.
Nearly 6% of patients who have a major complication after esophagectomy do not survive to discharge. Age greater than 75 years, black race, American Society of Anesthesiologists class 4 or 5, and complications related to major infection or organ failure predict FTR. Further research is necessary to investigate how these factors affect survival after complications in order to improve rescue efforts.
术后失败救治（Failure to Rescue，FTR）是一种越来越多地用于评估医疗质量的指标，其定义为发生重大并发症后导致的死亡。然而，此前尚未研究食管切除术后发生 FTR 的相关风险因素。
本研究在美国外科医师学会国家外科质量改进计划数据库中检索了 2010 年至 2014 年间接受胃管食管切除术的患者。根据住院期间死亡率（FTR 组）和存活至出院（SUR 组）将至少发生一种重大术后并发症的患者分为两组。采用逐步逻辑回归模型确定 FTR 的预测因素。
共有 1730 例患者纳入本研究，其中 FTR 组 102 例（5.9%），SUR 组 1628 例（94.1%）。FTR 患者的年龄大于 SUR 患者（69.0 岁比 64.0 岁，p<0.0001）。两组间在性别、体重指数、术前体重减轻、吸烟状态、手术类型或外科医生专业方面无差异。年龄大于 75 岁（调整后优势比 2.68，p<0.0001）、黑种人（调整后优势比 2.75，p=0.001）、美国麻醉医师协会 4 级或 5 级（调整后优势比 1.82，p=0.02）以及发生肺炎、呼吸衰竭、急性肾功能衰竭、脓毒症或急性心肌梗死与多变量逻辑回归分析的 FTR 相关。
近 6%的食管切除术后发生重大并发症的患者未存活至出院。年龄大于 75 岁、黑种人、美国麻醉医师协会 4 级或 5 级以及与重大感染或器官衰竭相关的并发症可预测 FTR。需要进一步研究这些因素如何影响并发症后的生存情况，以改善抢救工作。
