Postoperative mortality following oesophagectomy and problems in reporting its rate

Jamieson, Glyn G.; Mathew, George; Ludemann, R; Webb, John G.; Myers, Jennifer C.; Devitt, Peter G.

doi:10.1002/bjs.4596

Cited by 252 publications

(184 citation statements)

References 11 publications

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“…22,23 It is now argued that 1-year survival rates following surgical resection give a better indication of the true mortality outcomes in oesophageal cancer. 24 The 1-year survival rates give some guidance about the degree of patient selection and whether or not the operation was really worthwhile. Our results compare favourably with the 1-year survival rates of approximately 61% from a number of Western series unadjusted for staging from the 1990s.…”

Section: Table 2 Waiting Times To First Treatment January 2000 To Maymentioning

confidence: 99%

Centralisation of Oesophagogastric Cancer Services: Can Specialist Units Deliver?

Forshaw¹,

Gossage²,

Stephens³

et al. 2006

annals

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INTRODUCTION Oesophagogastric cancer surgery is increasingly being performed in only centralised units. The aim of the study was to examine surgical outcomes and service delivery within a specialist unit.PATIENTS AND METHODS The case notes of all patients undergoing attempted oesophagogastrectomy between January 2000 and May 2003 were identified from a prospective consultant database. RESULTS A total of 187 patients (median age, 63 years; range, 29-83 years; M:F ratio, 3.9:1) underwent attempted oesophagogastrectomy. Of these, 91% were seen within 2 weeks of referral and treatment was instituted after a mean of 31 days (range, 1-109 days). More patients underwent surgery (63%) than neoadjuvant therapy (56%) within 1 month of referral. The main indication for surgery was invasive malignancy in 166 patients (89%). The 30-day mortality was 0.5% (1 death) and in-hospital mortality was 1.1% (2 deaths). The median length of hospital stay was 14 days (range, 7-69 days). Significant postoperative morbidity included: pulmonary complications (36%), cardiovascular complications (16%), wound infection (13%) and clinically significant anastomotic leaks (7%). Of the study group, 28 patients (15%) were admitted to ICU with a median stay of 10 days (range, 1-44 days); this accounted for 0.9% of ICU bed availability. Twelve patients (6.4%) were returned to theatre, most commonly for bleeding. The 1-year survival rates were 78%. During 2002-2003, national waiting list targets for both hernia repair and cholecystectomy were achieved.CONCLUSIONS Despite recent increases in workload, high volume specialist units can deliver an efficient and timely service with both good treatment outcomes and minimal impact upon elective surgical waiting lists and ICU provision.

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Section: Table 2 Waiting Times To First Treatment January 2000 To Maymentioning

confidence: 99%

Centralisation of Oesophagogastric Cancer Services: Can Specialist Units Deliver?

Forshaw¹,

Gossage²,

Stephens³

et al. 2006

annals

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“…However, despite improvements in perioperative care, the operations are not without risk. Reviews of international studies concluded that postoperative death rates following oesophageal cancer operations were 8.9% in western countries (Jamieson et al, 2004), and that 30-day death rates following gastrectomy for cancer were 7.6% (Grossmann et al, 2002). Prognostic factors for postoperative hospital death after upper gastrointestinal tract (GI) cancer operations have been studied using multivariable logistic regression models comprising patient-related and hospital-related variables.…”

mentioning

confidence: 99%

Impact of socio-economic deprivation on death rates after surgery for upper gastrointestinal tract cancer

et al. 2006

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We hypothesised that socio-economic deprivation in England may be a prognostic factor for death after oesophagectomy or gastrectomy for cancer of the upper gastrointestinal tract. We analysed statistical data from hospital records linked to death records for patients who underwent operations for oesophageal and gastric cancer in England from April 1998 to March 2002. The patients were stratified into quintiles according to the index of multiple deprivation (IMD) (2000) for their place (ward) of residence. Age and sex standardised death rates at 30 and 90 days for each deprivation quintile were calculated. Following oesophagectomy, death rates showed a significant association with IMD. They increased with increasing levels of deprivation: the odds ratio for death, comparing highest with lowest quintile for deprivation, was 1.37 (95% confidence interval 1.03 -1.85) at 30 days and 1.30 (1.04 -1.64) at 90 days. Following gastrectomy, the death rates showed smaller and nonsignificant associations with IMD with odds ratios of 1.16 (0.84 -1.62) and 1.10 (0.86 -1.41), respectively. There is a significant association between social deprivation and death after oesophagectomy, but less of an association, if any, after gastrectomy in current UK practice.

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“…A review of esophagectomy outcomes for the 1990's showed a 8.8% in hospital mortality rate for this decade [26], although lower mortality (<5.0%) was observed in high volume centres [27]. More recent reports from the 2000's describe mortality rates of 3-5%, again with lower mortality rates consistently reported from high volume centres [28].…”

Section: Discussionmentioning

confidence: 99%

Modeling the Cost-effectiveness of Strategies for Treating Esophageal Adenocarcinoma and High-grade Dysplasia

Gordon

Hirst

Mayne

et al. 2012

Journal of Gastrointestinal Surgery

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Objective: To synthesize cost and health outcomes for current treatment pathways for esophageal adenocarcinoma and high grade dysplasia, and model comparative net clinical and economic benefits of alternative management scenarios. Methods Conclusion:These findings support measures that promote earlier diagnosis, such as developing risk assessment processes or endoscopic surveillance of Barrett's esophagus.Incremental net monetary benefits for other strategies are relatively small in comparison to predicted gains from early detection strategies.

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Postoperative mortality following oesophagectomy and problems in reporting its rate

Cited by 252 publications

References 11 publications

Centralisation of Oesophagogastric Cancer Services: Can Specialist Units Deliver?

Centralisation of Oesophagogastric Cancer Services: Can Specialist Units Deliver?

Impact of socio-economic deprivation on death rates after surgery for upper gastrointestinal tract cancer

Modeling the Cost-effectiveness of Strategies for Treating Esophageal Adenocarcinoma and High-grade Dysplasia

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