A 5 Year Analysis of Readmissions after Radical Subtotal Gastrectomy for Early Gastric Cancer

Kim, Min-Chan; Kim, Ki-Han; Jung, Ghap Joong

doi:10.1245/s10434-012-2271-0

Cited by 26 publications

(26 citation statements)

References 19 publications

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“…In this study 12.2% of patients required readmission, which is comparable to published data (7, 10, 14, 15). If included in the model for mortality, NSQIP defined readmission is associated with lower risk of mortality.…”

Section: Discussionsupporting

confidence: 90%

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Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Martin

Das

Turrentine

et al. 2016

Journal of Gastrointestinal Surgery

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Background Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy. Methods This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission and reoperation. Results 3,678 patients underwent gastrectomy. A majority of patients had distal gastrectomy (N= 2,799, 76.1%) and had resection for malignancy (N= 2,316, 63.0%). 798 patients (21.7%) experienced a major complication. Reoperation was required in 290 patients (7.9%). 30-day mortality was 5.2%. Age (OR=1.01, 95% CI: 1.01–1.02, p=0.001), preoperative malnutrition (OR=1.65, 95% CI: 1.35–2.02, p<0.001), total gastrectomy (OR=1.63, 95% CI: 1.31–2.03, p<0.001), benign indication for resection (OR=1.60, 95% CI: 1.29–1.97, p<0.001), blood transfusion (OR=2.57, 95% CI: 2.10–3.13, p<0.001), and intraoperative placement of a feeding tubes (OR=1.28, 95% CI: 1.00–1.62, p=0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR=1.23, 95% CI: 0.99–1.53, p=0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p<0.001). Conclusions Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.

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Section: Discussionsupporting

confidence: 90%

“…Institutional and registry data suggest an overall morbidity of approximately 20% and increased risk of readmissions among patients who developed complications (7, 10, 14, 15). The individual effects associated with specific and potentially modifiable risk factors remain poorly defined.…”

Section: Introductionmentioning

confidence: 99%

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Martin

Das

Turrentine

et al. 2016

Journal of Gastrointestinal Surgery

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“…Although our results were not directly comparable to those of Wang et al [16], those authors reported that readmission rates in ERAS and non-ERAS were 2.22 and 2.12%, and the main causes of readmission in ERAS and non-ERAS were gastric stasis and bowel obstruction, respectively. In this study, the most common readmission cause both within and after 30 days was bowel obstruction, and these results were comparable with other reports [26,27]. …”

Section: Discussionsupporting

confidence: 93%

The Clinical Indication and Feasibility of the Enhanced Recovery Protocol for Curative Gastric Cancer Surgery: Analysis of 147 Consecutive Experiences

Lee¹,

Jeon²

2014

Dig Surg

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Background: Radical gastrectomy for gastric cancer is one of the most invasive procedures in gastrointestinal surgery. A few studies have found that an enhanced recovery after surgery (ERAS) protocol is useful in radical gastrectomy. The aim of this study was to evaluate the appropriate indication and feasibility of an ERAS protocol in radical gastrectomy. Methods: We studied the clinical characteristics in 147 patients managed with an ERAS protocol after radical gastrectomy. Of these patients, the protocol was completely applied to 99 (group I), meaning 48 patients (group II) did not complete the protocol. Results: The age and ECOG (Eastern Cooperative Oncology Group) status of patients, extent of lymph node dissection, minilaparotomy and insertion of drains were significant influences on compliance to the ERAS protocol. Overall complication rates showed no difference between the two groups; however, local complications were more frequent in group II than group I. Regarding readmission rates within 30 days and after 30 days, there was no significant difference in the incidence and severity grades of causes of readmission between the two groups. Conclusions: The results of this study suggest that an ERAS protocol is feasible and safely applicable without increasing the morbidity and readmission rate after radical gastrectomy if it is applied to patients with positive and less invasive procedures. i 2014 S. Karger AG, Basel

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“…Gastric cancer is one of the most common digestive tract malignancies worldwide, and surgical resection is the only therapeutic modality for cure 1. The resection method includes total gastrectomy (TG) and subtotal gastrectomy (SG).…”

Section: Introductionmentioning

confidence: 99%

Total versus subtotal gastrectomy for distal gastric cancer: Meta-analysis of randomized clinical trials

Kong¹,

Yang²,

Shi³

et al. 2016

OTT

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ObjectivesThis meta-analysis of randomized controlled trials was conducted to give a more precise estimation of the efficacy and drawbacks of total gastrectomy (TG) versus subtotal gastrectomy (SG) for proven distal gastric cancer.MethodsThe electronic databases Cochrane and PubMed (updated on April 10, 2016) were searched for randomized controlled trials comparing TG with SG as surgical procedures for distal gastric cancer. Five outcome variables were analyzed, including postoperative complications, anastomotic fistula rate, hospital mortality rate, mortality rate of recurrence (the patient’s death is caused by the recurrence of gastric cancer, rather than caused by other diseases), and 5-year survival rate. Random or fixed effect model was used to perform this meta-analysis.ResultsSix trials, including 573 cases treated with TG and 791 cases treated with SG, were included. Compared with patients in the SG group, patients in the TG group did not show a higher rate of postoperative complications (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.71–3.03, P=0.30). However, patients in the TG group showed a significantly higher rate of anastomotic fistula than patients in the SG group (OR: 3.78, 95% CI: 1.97–7.27, P<0.0001). Hospital mortality rate, which was analyzed in four trials, including 510 TG versus 729 SG patients, showed no significant difference between the two groups (OR: 1.80, 95% CI: 0.85–3.78, P=0.12). Importantly, there was no significant difference in the 5-year survival between the two groups (OR: 0.68, 95% CI: 0.39–1.19, P=0.18). Mortality rate of recurrence, which was also analyzed in three trials, including 396 TG versus 407 SG patients, showed a significantly higher rate in the TG group (OR: 0.07, 95% CI: 0.01–0.13, P=0.03).ConclusionThis meta-analysis demonstrated that postoperative complications, hospital mortality rate, and 5-year survival rate in TG patients was similar to the SG group. Furthermore, SG was associated with significantly fewer anastomotic fistula and lower mortality rate of recurrence compared with TG. However, lower mortality rate of recurrence was probably related to the criteria of these two procedures.

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A 5 Year Analysis of Readmissions after Radical Subtotal Gastrectomy for Early Gastric Cancer

Cited by 26 publications

References 19 publications

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

The Clinical Indication and Feasibility of the Enhanced Recovery Protocol for Curative Gastric Cancer Surgery: Analysis of 147 Consecutive Experiences

Total versus subtotal gastrectomy for distal gastric cancer: Meta-analysis of randomized clinical trials

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