Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation. Results from the Dutch Upper Gastrointestinal Cancer Audit

Voeten, Daan M.; Werf, Leonie R. van der; Gisbertz, Suzanne S.; Ruurda, Jelle P.; Henegouwen, Mark I. van Berge; Hillegersberg, Richard van; Det, Marc J. van; Duijvendijk, Peter van; Esser, Stijn van; Harst, Erwin van der; Hartgrink, Henk H.; Heisterkamp, Joos; Nieuwenhuijzen, Grard A. P.; Peet, Donald L. van der; Pierie, Jean-Pierre E. N.; Rosman, Camiel; Sandick, Johanna W. van; Sosef, Meindert N.; Wijnhoven, Bas P. L.

doi:10.1016/j.ejso.2021.01.005

Cited by 10 publications

(9 citation statements)

References 24 publications

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“…In the Netherlands, esophagectomy and gastrectomy patients are generally extubated immediately after surgery. After esophagectomy, protocol length of postoperative ICU stay varies from 0 to 2 days among Dutch hospitals [19]. Standard procedure after gastrectomy is not to admit patients to the ICU.…”

Section: Ancillary Supportmentioning

confidence: 99%

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Minimally Invasive Oncologic Upper Gastrointestinal Surgery can be Performed Safely on all Weekdays: A Nationwide Cohort Study

et al. 2021

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Background Existing literature suggests deteriorating surgical outcome of esophagogastric surgery as the week progresses. However, these studies were conducted in the pre-centralization and pre-minimally invasive era. In addition, they failed to correct for fixed weekdays of esophagogastric cancer surgery among hospitals. This study aimed to describe the impact of weekday of minimally invasive upper gastrointestinal surgery on short-term surgical outcomes. Methods All patients registered in the Dutch Upper Gastrointestinal Cancer Audit who underwent curative minimally invasive esophageal or gastric carcinoma surgery in 2015–2019, were included in this nationwide cohort study. Using multilevel multivariable logistic regression, the impact of weekday of surgery on 14 short-term surgical outcomes was investigated. To correct for interhospital variance in fixed weekday(s) of surgery multilevel analyses was used. Results were adjusted for patient, tumor, and treatment characteristics using multivariable logistic regression analyses. Results This study included 4,102 patients undergoing minimally invasive upper gastrointestinal surgery (2,968 esophageal cancer and 1,134 gastric cancer patients). Weekday of surgery did not impact postoperative complications, severe postoperative complications, surgical/technical complications, medical complications, anastomotic leakage, complicated postoperative course, failure to rescue, surgical radicality, lymph node yield, 30-day/in-hospital mortality, reinterventions, length of ICU stay, 30-day readmission, and textbook outcome after neither esophageal cancer nor gastric cancer surgery. Conclusions Minimally invasive esophagogastric surgery can be performed safely on all weekdays with respect to short-term surgical outcomes, which is important information for operation room scheduling.

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Section: Ancillary Supportmentioning

confidence: 99%

“…16 ( 8) 40 ( 21) 33 ( 17) 54 ( 28) 50 (26) 168 (15) 211 (19) 213 (19) 269 (24) 273 ( 24 yield is lower after surgery late in the week. The current study did display significantly higher 30-day readmission rates after gastrectomy later in the week.…”

Section: Gastric Cancermentioning

confidence: 99%

Minimally Invasive Oncologic Upper Gastrointestinal Surgery can be Performed Safely on all Weekdays: A Nationwide Cohort Study

et al. 2021

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“… 25 , 26 A nationwide study of minimally invasive esophagectomy in the Netherlands demonstrated great heterogeneity in ICU LOS, pointing to differences in use of early extubation protocols and analgesic modalities as contributing factors. 27 Investigation at a broader scale is necessary to confirm the generalizability of our findings and to identify modifiable practice patterns that increase LOS.…”

Section: Discussionmentioning

confidence: 82%

Parsimonious machine learning models to predict resource use in cardiac surgery across a statewide collaborative

et al. 2022

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“…Prolonged ICU LoS refers to a period longer than 2 d (the day of surgery + 1 d) because based on the protocol in our center, a standard ICU stay is 1 or 2 d. A short ICU stay was associated with shorter overall hospital admission time and did not negatively impact short-term surgical outcomes[ 12 ]. Prolonged ICU LoS is a risk factor for mortality[ 2 ].…”

Section: Discussionmentioning

confidence: 99%

C-reactive protein as a non-linear predictor of prolonged length of intensive care unit stay after gastrointestinal cancer surgery

Yan¹,

Gao²,

Jin³

et al. 2022

World J Clin Cases

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BACKGROUND The relationship between C-reactive protein (CRP) levels and prolonged intensive care unit (ICU) length of stay (LoS) has not been well defined. AIM To explore the association between CRP levels at ICU admission and prolonged ICU LoS in gastrointestinal cancer (GC) patients after major surgery. METHODS A retrospective study was performed to quantify serum CRP levels and to establish their association with prolonged ICU LoS (≥ 72 h) in GC patients admitted to the ICU. Univariate and multivariate regression analyses were conducted, and restricted cubic spline curves with four knots (5%, 35%, 65%, 95%) were used to explore non-linearity assumptions. RESULTS A total of 408 patients were enrolled. Among them, 83 (20.3%) patients had an ICU LoS longer than 72 h. CRP levels were independently associated with the risk of prolonged ICU LoS [odds ratio (OR) 1.47, 95% confidence interval (CI) 1.00–2.17]. Restricted cubic spline analysis revealed a non-linear relationship between CRP levels and OR for the prolonged ICU LoS ( P = 0.035 for non-linearity). After the cut-off of 2.6 (log transformed mg/L), the OR for prolonged ICU LoS significantly increased with CRP levels. The adjusted regression coefficient was 0.70 (95%CI 0.31–1.57, P = 0.384) for CRP levels less than 2.6, whereas it was 2.43 (95%CI 1.39–4.24, P = 0.002) for CRP levels higher than 2.6. CONCLUSION Among the GC patients, CRP levels at ICU admission were non-linearly associated with prolonged ICU LoS in survivors. An admission CRP level > 2.6 (log transformed mg/L) was associated with increased risk of prolonged ICU LoS.

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Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation. Results from the Dutch Upper Gastrointestinal Cancer Audit

Cited by 10 publications

References 24 publications

Minimally Invasive Oncologic Upper Gastrointestinal Surgery can be Performed Safely on all Weekdays: A Nationwide Cohort Study

Minimally Invasive Oncologic Upper Gastrointestinal Surgery can be Performed Safely on all Weekdays: A Nationwide Cohort Study

Parsimonious machine learning models to predict resource use in cardiac surgery across a statewide collaborative

C-reactive protein as a non-linear predictor of prolonged length of intensive care unit stay after gastrointestinal cancer surgery

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