Key result
Treatment in low-mortality units was associated with significantly lower failure to rescue-surgical rates compared to high-mortality units (15.3% vs. 24.1%; P<0.001).
Why the study?
Does treatment in low-mortality units compared to high-mortality units improve survival following complications in patients undergoing gastroesophageal cancer surgery?
Cohort (n=25,626)
Yes
Does treatment in low-mortality units compared to high-mortality units improve survival following complications in patients undergoing gastroesophageal cancer surgery?
Absolute Event Rate: 15.3% vs 24.1%
p-value: p=<.001
Low-mortality units are more likely to reintervene and successfully rescue patients following complications from gastroesophageal cancer resections compared to high-mortality units.
Failure-to-rescue varies by center after gastroesophageal resections; supports process investigation but should not yet change referral patterns.
IMPORTANCE: Gastroesophageal cancer resections are associated with significant reintervention and perioperative mortality rates. OBJECTIVE: To compare outcomes following operative and nonoperative reinterventions between high- and low-mortality gastroesophageal cancer surgical units in England. DESIGN: All elective esophageal and gastric resections for cancer between 2000 and 2010 in English public hospitals were identified from a national administrative database. Units were divided into low- and high-mortality units (LMUs and HMUs, respectively) using a threshold of 5% or less for 30-day adjusted mortality. The groups were compared for reoperations and nonoperative reinterventions following complications. SETTING: Both LMUs and HMUs. PARTICIPANTS: Patients who underwent esophageal and gastric resections for cancer. EXPOSURE: Elective esophageal and gastric resections for cancer, with reoperations and nonoperative reinterventions following complications. MAIN OUTCOMES AND MEASURES: Failure to rescue is defined as the death of a patient following a complication; failure to rescue-surgical is defined as the death of a patient following reoperation for a surgical complication. RESULTS: There were 14 955 esophagectomies and 10 671 gastrectomies performed in 141 units. For gastroesophageal resections combined, adjusted mortality rates were 3.0% and 8.3% (P < .001) for LMUs and HMUs, respectively. Complications rates preceding reoperation were similar (5.4% for LMUs vs. 4.9% for HMUs; P = .11). The failure to rescue-surgical rates were lower in LMUs than in HMUs (15.3% vs. 24.1%; P < .001). The LMUs performed more nonoperative reinterventions than the HMUs did (6.7% vs. 4.7%; P < .001), with more patients surviving in LMUs than in HMUs (failure to rescue rate, 7.0% vs. 12.5%; P < .001). Overall, LMUs reintervened more than HMUs did (12.2% vs 9.6%; P < .001), and LMUs had lower failure to rescue rates following reintervention than HMUs did (9.0% vs. 18.3%; P = .001). All P values stated refer to 2-sided values. CONCLUSIONS AND RELEVANCE: Overall, LMUs were more likely to reintervene and rescue patients following gastroesophageal cancer resections in England. Patients were more likely to survive following both reoperations and nonsurgical interventions in LMUs.
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Almoudaris et al. (2013) conducted a cohort in Gastroesophageal cancer (n=25,626). Treatment in low-mortality units (LMUs) vs. Treatment in high-mortality units (HMUs) was evaluated on Failure to rescue-surgical (death following reoperation for a surgical complication) (p=<.001). Treatment in low-mortality units was associated with significantly lower failure to rescue-surgical rates compared to high-mortality units (15.3% vs. 24.1%; P<0.001).
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