OBJECTIVE: To describe causes of death in the first year after esophagectomy and determine the time frame that should be used for measurement of quality of surgery. A case-mix adjustment model was developed for the comparison between hospitals. BACKGROUND: The time period in which postoperative mortality should be measured as a performance indicator is debated. METHODS: Cause of death was identified for patients in a tertiary referral hospital who died within 1 year after surgery and classified as surgery related or not surgery related. Sensitivity and specificity for detecting deaths related to surgery were calculated for different periods of follow-up. Case-mix adjustment models for 30-day mortality (30DM), in-hospital mortality, and 90-day mortality (90DM) were developed. RESULTS: In total, 1282 patients underwent esophagectomy. 30DM was 2.9%, the in-hospital mortality rate was 5.1% and 90DM was 7%. Beyond 30 days, a substantial number of deaths were related to the operation, especially due to anastomotic leakage. Postdischarge nononcological mortality was most frequently caused by sudden death. One in 5 patients died because of recurrent disease, being the most important threat in the first year after surgery. The 30DM had a sensitivity for detecting surgery-related deaths of 33% and a specificity of 100%. The 90DM had a sensitivity of 74% and a specificity of 96%. CONCLUSIONS: A period of postoperative follow-up longer than 30 days needs to be considered when comparing surgical performance between institutes. In the case-mix adjustment model for 90DM, no other variables have to be taken into account compared to those involved in 30DM.
OBJECTIVE: To describe causes of death in the first year after esophagectomy and determine the time frame that should be used for measurement of quality of surgery. A case-mix adjustment model was developed for the comparison between hospitals. BACKGROUND: The time period in which postoperative mortality should be measured as a performance indicator is debated. METHODS: Cause of death was identified for patients in a tertiary referral hospital who died within 1 year after surgery and classified as surgery related or not surgery related. Sensitivity and specificity for detecting deaths related to surgery were calculated for different periods of follow-up. Case-mix adjustment models for 30-day mortality (30DM), in-hospital mortality, and 90-day mortality (90DM) were developed. RESULTS: In total, 1282 patients underwent esophagectomy. 30DM was 2.9%, the in-hospital mortality rate was 5.1% and 90DM was 7%. Beyond 30 days, a substantial number of deaths were related to the operation, especially due to anastomotic leakage. Postdischarge nononcological mortality was most frequently caused by sudden death. One in 5 patients died because of recurrent disease, being the most important threat in the first year after surgery. The 30DM had a sensitivity for detecting surgery-related deaths of 33% and a specificity of 100%. The 90DM had a sensitivity of 74% and a specificity of 96%. CONCLUSIONS: A period of postoperative follow-up longer than 30 days needs to be considered when comparing surgical performance between institutes. In the case-mix adjustment model for 90DM, no other variables have to be taken into account compared to those involved in 30DM.
Authors: Ibrahim Nassour; Linda S Hynan; Alana Christie; Rebecca M Minter; Adam C Yopp; Michael A Choti; John C Mansour; Matthew R Porembka; Sam C Wang Journal: J Gastrointest Surg Date: 2017-11-10 Impact factor: 3.452
Authors: Felix Berlth; Marc Bludau; Patrick Sven Plum; Till Herbold; Hildegard Christ; Hakan Alakus; Robert Kleinert; Christiane Josephine Bruns; Arnulf Heinrich Hölscher; Seung-Hun Chon Journal: J Gastrointest Surg Date: 2018-10-29 Impact factor: 3.452
Authors: Ali A Mokdad; Adam C Yopp; Patricio M Polanco; John C Mansour; Scott I Reznik; Daniel F Heitjan; Michael A Choti; Rebecca R Minter; Sam C Wang; Matthew R Porembka Journal: JAMA Oncol Date: 2018-01-01 Impact factor: 31.777