Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue

TENTACLE – Esophagus collaborative group; Study collaborators; Sander Ubels; Eric Matthée; Moniek Verstegen; Bastiaan Klarenbeek; Stefan Bouwense; Mark I. van Berge Henegouwen; Freek Daams; Jan Willem T. Dekker; Marc J. van Det; Stijn van Esser; Ewen A. Griffiths; Jan Willem Haveman; Grard Nieuwenhuijzen; Peter D. Siersema; Bas Wijnhoven; Gerjon Hannink; Frans van Workum; Camiel Rosman

doi:10.1016/j.ejso.2023.01.010

Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue

TENTACLE – Esophagus collaborative group, Study collaborators, Sander Ubels^*, Eric Matthée, Moniek Verstegen, Bastiaan Klarenbeek, Stefan Bouwense, Mark I. van Berge Henegouwen, Freek Daams, Jan Willem T. Dekker, Marc J. van Det, Stijn van Esser, Ewen A. Griffiths, Jan Willem Haveman, Grard Nieuwenhuijzen, Peter D. Siersema, Bas Wijnhoven, Gerjon Hannink, Frans van Workum, Camiel Rosman

^*Corresponding author voor dit werk

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Introduction: Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main contributor to FTR. This study aimed to assess differences in FTR after AL between centers, and to identify factors that explain these differences.

Methods: TENTACLE – Esophagus is a multicenter, retrospective cohort study, which included 1509 patients with AL after esophagectomy. Differences in FTR were assessed between low-volume (<20 resections), middle-volume (20–60 resections) and high-volume centers (≥60 resections). Mediation analysis was performed using logistic regression, including possible mediators for FTR: case-mix, hospital resources, leak severity and treatment.

Results: FTR after AL was 11.7%. After adjustment for confounders, FTR was lower in high-volume vs. low-volume (OR 0.44, 95%CI 0.2–0.8), but not versus middle-volume centers (OR 0.67, 95%CI 0.5–1.0). After mediation analysis, differences in FTR were found to be explained by lower leak severity, lower secondary ICU readmission rate and higher availability of therapeutic modalities in high-volume centers. No statistically significant direct effect of hospital volume was found: high-volume vs. low-volume 0.86 (95%CI 0.4–1.7), high-volume vs. middle-volume OR 0.86 (95%CI 0.5–1.4).

Conclusion: Lower FTR in high-volume compared with low-volume centers was explained by lower leak severity, less secondary ICU readmissions and higher availability of therapeutic modalities. To reduce FTR after AL, future studies should investigate effective strategies to reduce leak severity and prevent secondary ICU readmission.

Originele taal-2	English
Pagina's (van-tot)	974-982
Aantal pagina's	9
Tijdschrift	European Journal of Surgical Oncology
Volume	49
Nummer van het tijdschrift	5
DOI's	https://doi.org/10.1016/j.ejso.2023.01.010
Status	Published - mei-2023

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Erratum to “Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue”: [Eur J Surg Oncol 49 (5) (May 2023) 974–982](S074879832300032X)(10.1016/j.ejso.2023.01.010)
TENTACLE – Esophagus collaborative group, Ubels, S., Matthée, E., Verstegen, M., Klarenbeek, B., Bouwense, S., van Berge Henegouwen, M. I., Daams, F., Dekker, J. W. T., van Det, M. J., van Esser, S., Griffiths, E. A., Haveman, J. W., Nieuwenhuijzen, G., Siersema, P. D., Wijnhoven, B., Hannink, G., van Workum, F. & Rosman, C., sep.-2023, In: European Journal of Surgical Oncology. 49, 9, 106993.
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TENTACLE – Esophagus collaborative group, Study collaborators, Ubels, S., Matthée, E., Verstegen, M., Klarenbeek, B., Bouwense, S., van Berge Henegouwen, M. I., Daams, F., Dekker, J. W. T., van Det, M. J., van Esser, S., Griffiths, E. A., Haveman, J. W., Nieuwenhuijzen, G., Siersema, P. D., Wijnhoven, B., Hannink, G., van Workum, F., & Rosman, C. (2023). Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue. European Journal of Surgical Oncology, 49(5), 974-982. https://doi.org/10.1016/j.ejso.2023.01.010

@article{402a323ca47e4ab9826e59474319784a,

title = "Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue",

abstract = "Introduction: Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main contributor to FTR. This study aimed to assess differences in FTR after AL between centers, and to identify factors that explain these differences.Methods: TENTACLE – Esophagus is a multicenter, retrospective cohort study, which included 1509 patients with AL after esophagectomy. Differences in FTR were assessed between low-volume (<20 resections), middle-volume (20–60 resections) and high-volume centers (≥60 resections). Mediation analysis was performed using logistic regression, including possible mediators for FTR: case-mix, hospital resources, leak severity and treatment.Results: FTR after AL was 11.7%. After adjustment for confounders, FTR was lower in high-volume vs. low-volume (OR 0.44, 95%CI 0.2–0.8), but not versus middle-volume centers (OR 0.67, 95%CI 0.5–1.0). After mediation analysis, differences in FTR were found to be explained by lower leak severity, lower secondary ICU readmission rate and higher availability of therapeutic modalities in high-volume centers. No statistically significant direct effect of hospital volume was found: high-volume vs. low-volume 0.86 (95%CI 0.4–1.7), high-volume vs. middle-volume OR 0.86 (95%CI 0.5–1.4).Conclusion: Lower FTR in high-volume compared with low-volume centers was explained by lower leak severity, less secondary ICU readmissions and higher availability of therapeutic modalities. To reduce FTR after AL, future studies should investigate effective strategies to reduce leak severity and prevent secondary ICU readmission.",

keywords = "Anastomotic leak, Complications, Esophagectomy, Failure to rescue, Practice variation",

author = "{TENTACLE – Esophagus collaborative group} and {Study collaborators} and Sander Ubels and Eric Matth{\'e}e and Moniek Verstegen and Bastiaan Klarenbeek and Stefan Bouwense and {van Berge Henegouwen}, {Mark I.} and Freek Daams and Dekker, {Jan Willem T.} and {van Det}, {Marc J.} and {van Esser}, Stijn and Griffiths, {Ewen A.} and Haveman, {Jan Willem} and Grard Nieuwenhuijzen and Siersema, {Peter D.} and Bas Wijnhoven and Gerjon Hannink and {van Workum}, Frans and Camiel Rosman and Slootmans, {Cettela A.M.} and Gijs Ultee and Gisbertz, {Suzanne S.} and Eshuis, {Wietse J.} and Kalff, {Marianne C.} and Feenstra, {Minke L.} and {van der Peet}, {Donald L.} and Stam, {Wessel T.} and {van Etten}, Boudewijn and Floris Poelmann and Nienke Vuurberg and {Willem van den Berg}, Jan and Martijnse, {Ingrid S.} and Matthijsen, {Robert M.} and Misha Luyer and Wout Curvers and Tom Nieuwenhuijzen and Taselaar, {Annick E.} and Kouwenhoven, {Ewout A.} and Merel Lubbers and Meindert Sosef and Frederik Lecot and Geraedts, {Tessa C.M.} and {van den Wildenberg}, Frits and Wendy Kelder and Baas, {Peter C.} and {de Haas}, {Job W.A.} and Hartgrink, {Henk H.} and Pepijn Weeder and Marije Zwakman and Ahmed Ahmed and Jeroen Schouten",

note = "Funding Information: The TENTACLE – Esophagus study received funding from Medtronic company. The study was performed independently, and Medtronic had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit to manuscript. Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = may,

doi = "10.1016/j.ejso.2023.01.010",

language = "English",

volume = "49",

pages = "974--982",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "ELSEVIER SCI LTD",

number = "5",

}

TENTACLE – Esophagus collaborative group, Study collaborators, Ubels, S, Matthée, E, Verstegen, M, Klarenbeek, B, Bouwense, S, van Berge Henegouwen, MI, Daams, F, Dekker, JWT, van Det, MJ, van Esser, S, Griffiths, EA, Haveman, JW, Nieuwenhuijzen, G, Siersema, PD, Wijnhoven, B, Hannink, G, van Workum, F & Rosman, C 2023, 'Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue', European Journal of Surgical Oncology, vol. 49, nr. 5, blz. 974-982. https://doi.org/10.1016/j.ejso.2023.01.010

TY - JOUR

T1 - Practice variation in anastomotic leak after esophagectomy

T2 - Unravelling differences in failure to rescue

AU - TENTACLE – Esophagus collaborative group

AU - Study collaborators

AU - Ubels, Sander

AU - Matthée, Eric

AU - Verstegen, Moniek

AU - Klarenbeek, Bastiaan

AU - Bouwense, Stefan

AU - van Berge Henegouwen, Mark I.

AU - Daams, Freek

AU - Dekker, Jan Willem T.

AU - van Det, Marc J.

AU - van Esser, Stijn

AU - Griffiths, Ewen A.

AU - Haveman, Jan Willem

AU - Nieuwenhuijzen, Grard

AU - Siersema, Peter D.

AU - Wijnhoven, Bas

AU - Hannink, Gerjon

AU - van Workum, Frans

AU - Rosman, Camiel

AU - Slootmans, Cettela A.M.

AU - Ultee, Gijs

AU - Gisbertz, Suzanne S.

AU - Eshuis, Wietse J.

AU - Kalff, Marianne C.

AU - Feenstra, Minke L.

AU - van der Peet, Donald L.

AU - Stam, Wessel T.

AU - van Etten, Boudewijn

AU - Poelmann, Floris

AU - Vuurberg, Nienke

AU - Willem van den Berg, Jan

AU - Martijnse, Ingrid S.

AU - Matthijsen, Robert M.

AU - Luyer, Misha

AU - Curvers, Wout

AU - Nieuwenhuijzen, Tom

AU - Taselaar, Annick E.

AU - Kouwenhoven, Ewout A.

AU - Lubbers, Merel

AU - Sosef, Meindert

AU - Lecot, Frederik

AU - Geraedts, Tessa C.M.

AU - van den Wildenberg, Frits

AU - Kelder, Wendy

AU - Baas, Peter C.

AU - de Haas, Job W.A.

AU - Hartgrink, Henk H.

AU - Weeder, Pepijn

AU - Zwakman, Marije

AU - Ahmed, Ahmed

AU - Schouten, Jeroen

N1 - Funding Information: The TENTACLE – Esophagus study received funding from Medtronic company. The study was performed independently, and Medtronic had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit to manuscript. Publisher Copyright: © 2023 The Authors

PY - 2023/5

Y1 - 2023/5

N2 - Introduction: Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main contributor to FTR. This study aimed to assess differences in FTR after AL between centers, and to identify factors that explain these differences.Methods: TENTACLE – Esophagus is a multicenter, retrospective cohort study, which included 1509 patients with AL after esophagectomy. Differences in FTR were assessed between low-volume (<20 resections), middle-volume (20–60 resections) and high-volume centers (≥60 resections). Mediation analysis was performed using logistic regression, including possible mediators for FTR: case-mix, hospital resources, leak severity and treatment.Results: FTR after AL was 11.7%. After adjustment for confounders, FTR was lower in high-volume vs. low-volume (OR 0.44, 95%CI 0.2–0.8), but not versus middle-volume centers (OR 0.67, 95%CI 0.5–1.0). After mediation analysis, differences in FTR were found to be explained by lower leak severity, lower secondary ICU readmission rate and higher availability of therapeutic modalities in high-volume centers. No statistically significant direct effect of hospital volume was found: high-volume vs. low-volume 0.86 (95%CI 0.4–1.7), high-volume vs. middle-volume OR 0.86 (95%CI 0.5–1.4).Conclusion: Lower FTR in high-volume compared with low-volume centers was explained by lower leak severity, less secondary ICU readmissions and higher availability of therapeutic modalities. To reduce FTR after AL, future studies should investigate effective strategies to reduce leak severity and prevent secondary ICU readmission.

AB - Introduction: Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main contributor to FTR. This study aimed to assess differences in FTR after AL between centers, and to identify factors that explain these differences.Methods: TENTACLE – Esophagus is a multicenter, retrospective cohort study, which included 1509 patients with AL after esophagectomy. Differences in FTR were assessed between low-volume (<20 resections), middle-volume (20–60 resections) and high-volume centers (≥60 resections). Mediation analysis was performed using logistic regression, including possible mediators for FTR: case-mix, hospital resources, leak severity and treatment.Results: FTR after AL was 11.7%. After adjustment for confounders, FTR was lower in high-volume vs. low-volume (OR 0.44, 95%CI 0.2–0.8), but not versus middle-volume centers (OR 0.67, 95%CI 0.5–1.0). After mediation analysis, differences in FTR were found to be explained by lower leak severity, lower secondary ICU readmission rate and higher availability of therapeutic modalities in high-volume centers. No statistically significant direct effect of hospital volume was found: high-volume vs. low-volume 0.86 (95%CI 0.4–1.7), high-volume vs. middle-volume OR 0.86 (95%CI 0.5–1.4).Conclusion: Lower FTR in high-volume compared with low-volume centers was explained by lower leak severity, less secondary ICU readmissions and higher availability of therapeutic modalities. To reduce FTR after AL, future studies should investigate effective strategies to reduce leak severity and prevent secondary ICU readmission.

KW - Anastomotic leak

KW - Complications

KW - Esophagectomy

KW - Failure to rescue

KW - Practice variation

U2 - 10.1016/j.ejso.2023.01.010

DO - 10.1016/j.ejso.2023.01.010

M3 - Article

C2 - 36732207

AN - SCOPUS:85149737025

SN - 0748-7983

VL - 49

SP - 974

EP - 982

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 5

ER -

Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue

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Erratum to “Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue”: [Eur J Surg Oncol 49 (5) (May 2023) 974–982](S074879832300032X)(10.1016/j.ejso.2023.01.010)

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