FAILURE TO RESCUE AFTER GASTRECTOMY: A NEW INDICATOR OF SURGICAL QUALITY.
Journal
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery
ISSN: 2317-6326
Titre abrégé: Arq Bras Cir Dig
Pays: Brazil
ID NLM: 9100283
Informations de publication
Date de publication:
2023
2023
Historique:
received:
03
08
2023
accepted:
06
09
2023
medline:
27
11
2023
pubmed:
17
11
2023
entrez:
16
11
2023
Statut:
epublish
Résumé
The main treatment modality for gastric cancer is surgical resection with lymphadenectomy. Despite advances in perioperative care, major surgical complications can occur in up to 20% of cases. To determine the quality of surgical care employed, a new indicator called failure to rescue (FTR) was proposed, which assesses the percentage of patients who die after complications occur. To assess the rate of FTR after gastrectomy and factors associated with its occurrence. Patients with gastric cancer who underwent gastrectomy with curative intent were retrospectively evaluated. According to the occurrence of postoperative complications, patients were divided into FTR group (grade V complications) and rescued group (grade III/IV complications). Among the 731 patients, 114 had major complications. Of these patients, 76 (66.7%) were successfully treated for the complication (rescued group), while 38 (33.3%) died (FTR group). Patients in the FTR group were older (p=0.008; p<0.05), had lower levels of hemoglobin (p=0.021; p<0.05) and albumin (p=0.002; p<0.05), and a higher frequency of ASA III/IV (p=0.033; p<0.05). There were no differences between the groups regarding surgical and pathological characteristics. Clinical complications had a higher mortality rate (40.0% vs 30.4%), with pulmonary complications (50.2%) and infections (46.2%) being the most lethal. Patients with major complications grade III/IV had worse survival than those without complications. The FTR rate was 33.3%. Advanced age, worse performance, and nutritional parameters were associated with FTR.
Sections du résumé
BACKGROUND
BACKGROUND
The main treatment modality for gastric cancer is surgical resection with lymphadenectomy. Despite advances in perioperative care, major surgical complications can occur in up to 20% of cases. To determine the quality of surgical care employed, a new indicator called failure to rescue (FTR) was proposed, which assesses the percentage of patients who die after complications occur.
AIMS
OBJECTIVE
To assess the rate of FTR after gastrectomy and factors associated with its occurrence.
METHODS
METHODS
Patients with gastric cancer who underwent gastrectomy with curative intent were retrospectively evaluated. According to the occurrence of postoperative complications, patients were divided into FTR group (grade V complications) and rescued group (grade III/IV complications).
RESULTS
RESULTS
Among the 731 patients, 114 had major complications. Of these patients, 76 (66.7%) were successfully treated for the complication (rescued group), while 38 (33.3%) died (FTR group). Patients in the FTR group were older (p=0.008; p<0.05), had lower levels of hemoglobin (p=0.021; p<0.05) and albumin (p=0.002; p<0.05), and a higher frequency of ASA III/IV (p=0.033; p<0.05). There were no differences between the groups regarding surgical and pathological characteristics. Clinical complications had a higher mortality rate (40.0% vs 30.4%), with pulmonary complications (50.2%) and infections (46.2%) being the most lethal. Patients with major complications grade III/IV had worse survival than those without complications.
CONCLUSIONS
CONCLUSIONS
The FTR rate was 33.3%. Advanced age, worse performance, and nutritional parameters were associated with FTR.
Identifiants
pubmed: 37971027
pii: S0102-67202023000100339
doi: 10.1590/0102-672020230056e1774
pmc: PMC10642953
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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