Postoperative Complications Drive Unplanned Readmissions After Esophagectomy for Cancer

Bhagat, Rohun; Bronsert, Michael; Juaréz-Colunga, Elizabeth; Weyant, Michael J.; Mitchell, John D.; Glebova, Natalia O.; Henderson, William G.; Fullerton, David A.; Meguid, Robert A.

doi:10.1016/j.athoracsur.2017.12.024

Cited by 35 publications

(27 citation statements)

References 22 publications

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“…Several studies investigated hospital readmission after esophagectomy, with readmission occurring in 11.2% to 18.6% [13,14,[38][39][40]. These rates are higher than the 6.2% found in the current study but many of these studies found post-operative complications to be the biggest risk factor for a readmission.…”

Section: Discussioncontrasting

confidence: 69%

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

et al. 2020

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Background Within the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay after esophageal cancer surgery and its association with 30-day readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients with an uneventful recovery after esophagectomy. Methods All patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) who underwent a potentially curative esophagectomy between 2015 and 2018 were considered for inclusion. Patients were excluded in case of an intraoperative/post-operative complication, readmission to the intensive care unit, or any re-intervention. Length of hospital stay was dichotomized around the national median into ‘short admissions’ and ‘long admissions’. Hospital variation was evaluated using a case-mix-corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with 30-day readmission rates was investigated using the χ2-statistic. Results A total of 1007 patients was included. National median length of hospital stay was 9 days, ranging from 6.5 to 12.5 days among 17 hospitals. The percentage of ‘short admissions’ per hospital ranged from 7.7 to 93.5%. After correction for case-mix variables, 3 hospitals had significantly higher ‘short admission’ rates and 4 hospitals had significantly lower ‘short admission’ rates. Overall, 6.2% [hospital variation (0.0–13.2%)] of patients were readmitted. Hospital 30-day readmission rates were not significantly different between patients with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19). Conclusions Based on these nationwide audit data, median length of hospital stay after an uncomplicated esophagectomy was 9 days ranging from 6.5 to 12.5 days among Dutch hospitals. There was no association between length of hospital stay and readmission rates. Nationwide improvement might lead to a substantial reduction of hospital costs.

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Section: Discussioncontrasting

confidence: 69%

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

et al. 2020

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“…It is reported that about 38.1% of the patients experienced ≥ 1 complications within 30 days following esophagectomy; whereas 10.7% of them experienced unplanned readmissions due to inflammation and pulmonary/gastrointestinal complications. [1] Moreover, the pulmonary complications and anastomotic leakage (AL) might result in decreased long-term survival of the patients after esophagectomy. [2] Furthermore, AL is associated with increased morbidity and mortality due to mediastinitis and thoracic contamination.…”

Section: Introductionmentioning

confidence: 99%

Late-onset anastomotic leak following sweet esophagectomy

et al. 2020

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Rationale: Late-onset anastomotic leak (AL) is an uncommon but potentially lethal complication after esophagectomy. Patient concerns: A 74-year-old male patient was readmitted due to chest distress and chills about 3 months after initial esophagectomy for cancer. Diagnoses: The previous endoscopic biopsy revealed primary esophageal squamous cell carcinoma, and sweet esophagectomy with gastric conduit reconstruction was therefore performed. The patient developed AL 3 months after the surgery. Interventions: Naso-leakage extraluminal drainage tube was utilized because the symptoms of the patient were aggravated 1 month after the chest tube drainage since his second admission for AL. Outcomes: Twenty-one days after naso-leakage extraluminal drainage, the computed tomography images showed the healing of the leakage. Then the patient was discharged from the hospital. Lessons: Late-onset AL should be kept in mind when the patient complained of chest distress and fever during the follow up after esophagectomy. In addition, naso-leakage extraluminal drainage could be considered for the treatment of AL. Further trials for better evidence are warranted.

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“…It may seem intuitive that a potential reverse relationship exists between the hospital stay and readmission rates, where too much emphasis on reducing hospital stay may increase the likelihood of readmission, as some have reported (4). Several other published studies, however, dispute this finding by reporting a higher readmission rate in patients who had a previous longer hospital stay, which reflects the higher morbidity rate in this subgroup of patients (5).…”

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confidence: 99%

Readmission after esophageal resection for esophageal cancer: incidence and risk factors

Singhal

Mittal

2020

J Thorac Dis

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Postoperative Complications Drive Unplanned Readmissions After Esophagectomy for Cancer

Cited by 35 publications

References 22 publications

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

Late-onset anastomotic leak following sweet esophagectomy

Readmission after esophageal resection for esophageal cancer: incidence and risk factors

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