Peter McCulloch1, Jeremy Ward, Paris P Tekkis. 1. Academic Unit of Surgery, University of Liverpool, University Hospital Aintree, Liverpool L9 7AL. petermcculloch@aol.com
Abstract
OBJECTIVE: To evaluate the effect of comorbidity and other risk factors on postoperative mortality and morbidity in patients undergoing major oesophageal and gastric surgery. DESIGN: Multicentre cohort study with data on postoperative mortality and morbidity in hospital. DATA SOURCE AND METHODS: The ASCOT prospective database, comprising 2087 patients with newly diagnosed oesophageal and gastric cancer in 24 hospitals in England and Wales between 1 January 1999 and 31 December 2002. Multivariate logistic regression analysis was used to model the risk of death and postoperative complications. RESULTS: 955 patients underwent oesophagectomy or gastrectomy. Of these, 253 (27%) were graded ASA III or IV, and 187 (20%) had a high physiological POSSUM score (>or= 20). Operative mortality was 12% (111/955). Physiological POSSUM score, surgeon's assessment, type of operation, hospital case volume, and tumour stage independently predicted operative mortality. Medical complications were associated with higher physiological POSSUM scores and ASA grade, oesophagectomy or total gastrectomy, thoracotomy, and radical nodal dissection. Stage and additional organ resection predicted surgical (technical) complications. CONCLUSIONS: Many patients undergoing surgery for gastro-oesophageal cancer have major comorbid disease, which strongly influences their risk of postoperative death. Technical complications do not seem to be influenced by preoperative factors but reflect the extent of surgery and perhaps surgical judgment. Detailed prospective multicentre cooperative audit, with appropriate risk adjustment, is fundamental in the evaluation of cancer care and must be properly resourced.
OBJECTIVE: To evaluate the effect of comorbidity and other risk factors on postoperative mortality and morbidity in patients undergoing major oesophageal and gastric surgery. DESIGN: Multicentre cohort study with data on postoperative mortality and morbidity in hospital. DATA SOURCE AND METHODS: The ASCOT prospective database, comprising 2087 patients with newly diagnosed oesophageal and gastric cancer in 24 hospitals in England and Wales between 1 January 1999 and 31 December 2002. Multivariate logistic regression analysis was used to model the risk of death and postoperative complications. RESULTS: 955 patients underwent oesophagectomy or gastrectomy. Of these, 253 (27%) were graded ASA III or IV, and 187 (20%) had a high physiological POSSUM score (>or= 20). Operative mortality was 12% (111/955). Physiological POSSUM score, surgeon's assessment, type of operation, hospital case volume, and tumour stage independently predicted operative mortality. Medical complications were associated with higher physiological POSSUM scores and ASA grade, oesophagectomy or total gastrectomy, thoracotomy, and radical nodal dissection. Stage and additional organ resection predicted surgical (technical) complications. CONCLUSIONS: Many patients undergoing surgery for gastro-oesophageal cancer have major comorbid disease, which strongly influences their risk of postoperative death. Technical complications do not seem to be influenced by preoperative factors but reflect the extent of surgery and perhaps surgical judgment. Detailed prospective multicentre cooperative audit, with appropriate risk adjustment, is fundamental in the evaluation of cancer care and must be properly resourced.
Authors: P Aylin; B Alves; N Best; A Cook; P Elliott; S J Evans; A E Lawrence; G D Murray; J Pollock; D Spiegelhalter Journal: Lancet Date: 2001-07-21 Impact factor: 79.321
Authors: Brittany L Willer; Sumeet K Mittal; Stephanie G Worrell; Seemal Mumtaz; Tommy H Lee Journal: J Gastrointest Surg Date: 2010-06-08 Impact factor: 3.452
Authors: Patrick J McLaren; Nathan W Bronson; Kyle D Hart; Gina M Vaccaro; Ken M Gatter; Charles R Thomas; John G Hunter; James P Dolan Journal: J Gastrointest Surg Date: 2017-01-12 Impact factor: 3.452
Authors: Hemant M Kocher; Paris P Tekkis; Palepu Gopal; Ameet G Patel; Simon Cottam; Irving S Benjamin Journal: World J Gastroenterol Date: 2005-04-28 Impact factor: 5.742
Authors: Donald E Low; Sonia Kunz; Drew Schembre; Henry Otero; Tom Malpass; Alex Hsi; Guobin Song; Richard Hinke; Richard A Kozarek Journal: J Gastrointest Surg Date: 2007-08-31 Impact factor: 3.452