Allaway Matthew G R, Pham Helen, Zeng Mingjuan, Sinclair Jane-Louise B, Johnston Emma, Richardson Arthur, Hollands Michael
Department of Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia.
School of Medicine, Blacktown & Mount Druitt Medical School, Western Sydney University, Blacktown, New South Wales, Australia.
ANZ J Surg. 2024 Oct;94(10):1710-1714. doi: 10.1111/ans.19004. Epub 2024 Apr 22.
Failure to rescue (FTR), defined as death after a major complication, is increasingly being used as a surrogate for assessing quality of care following major cancer resection. The aim of this paper is to determine the failure to rescue (FTR) rate after oesophagectomy and explore factors that may contribute to FTR within Australia.
A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2015 to 2023 at five Australian hospitals was conducted to identify patients who underwent an oesophagectomy. The primary outcome was FTR rate. Perioperative parameters were examined to evaluate predictive factors for FTR. Secondary outcomes include major complications, overall morbidity, mortality, length of stay and 30-day readmissions.
A total of 155 patients were included with a median age of 65.2 years, 74.8% being male. The FTR rate was 6.3%. In total, 50.3% of patients (n = 78) developed at least one postoperative complication with the most common complication being pneumonia (20.6%) followed by prolonged intubation (12.9%) and organ space SSI/anastomotic leak (11.0%). Multivariate logistic regression analysis was performed to determine any factors that were predictive for FTR however none reached statistical significance.
This study is the first to evaluate the FTR rates following oesophagectomy within Australia, with FTR rates and complication profile comparable to international benchmarks. Integration of multi-institutional national databases such as ACS NSQIP into units is essential to monitor and compare patient outcomes following major cancer surgery, especially in low to moderate volume centres.
未能挽救（FTR）被定义为重大并发症后的死亡，越来越多地被用作评估重大癌症切除术后护理质量的替代指标。本文旨在确定食管癌切除术后的未能挽救（FTR）率，并探讨澳大利亚境内可能导致FTR的因素。
对澳大利亚五家医院2015年至2023年美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库进行回顾性研究，以确定接受食管癌切除术的患者。主要结局是FTR率。检查围手术期参数以评估FTR的预测因素。次要结局包括重大并发症、总体发病率、死亡率、住院时间和30天再入院率。
共纳入155例患者，中位年龄65.2岁，74.8%为男性。FTR率为6.3%。共有50.3%的患者（n = 78）发生至少一种术后并发症，最常见的并发症是肺炎（20.6%），其次是长时间插管（12.9%）和器官腔隙手术部位感染/吻合口漏（11.0%）。进行多因素逻辑回归分析以确定任何预测FTR的因素，但均未达到统计学意义。
本研究是首次评估澳大利亚境内食管癌切除术后的FTR率，FTR率和并发症情况与国际基准相当。将ACS NSQIP等多机构国家数据库整合到各单位对于监测和比较重大癌症手术后的患者结局至关重要，尤其是在手术量低至中等的中心。
