Root cause analysis of mortality after esophagectomy for cancer: a multicenter cohort study from the FREGAT database.

Journal

Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347

Informations de publication

Date de publication:
18 Apr 2024
Historique:
received: 11 08 2023
revised: 17 01 2024
accepted: 10 03 2024
medline: 20 4 2024
pubmed: 20 4 2024
entrez: 19 4 2024
Statut: aheadofprint

Résumé

Esophagectomy is associated with significant mortality. A better understanding of the causes leading to death may help to reduce mortality. A root cause analysis of mortality after esophagectomy was performed. Root cause analysis was retrospectively applied by an independent expert panel of 4 upper gastrointestinal surgeons and 1 anesthesiologist-intensivist to patients included in the French national multicenter prospective cohort FREGAT between August 2014 and September 2019 who underwent an esophagectomy for cancer and died within 90 days of surgery. A cause-and-effect diagram was used to determine the root causes related to death. Death was classified as potentially preventable or non-preventable. Among the 1,040 patients included in the FREGAT cohort, 70 (6.7%) patients (male: 81%, median age 68 [62-72] years) from 17 centers were included. Death was potentially preventable in 37 patients (53%). Root causes independently associated with preventable death were inappropriate indication (odds ratio 35.16 [2.50-494.39]; P = .008), patient characteristics (odds ratio 5.15 [1.19-22.35]; P = .029), unexpected intraoperative findings (odds ratio 18.99 [1.07-335.55]; P = .045), and delay in diagnosis of a complication (odds ratio 98.10 [6.24-1,541.04]; P = .001). Delay in treatment of a complication was found only in preventable deaths (28 [76%] vs 0; P < .001). National guidelines were less frequently followed (16 [43%] vs 22 [67%]; P = .050) in preventable deaths. The only independent risk factor of preventable death was center volume <26 esophagectomies per year (odds ratio 4.71 [1.55-14.33]; P = .006). More than one-half of deaths after esophagectomy were potentially preventable. Better patient selection, early diagnosis, and adequate management of complications through centralization could reduce mortality.

Sections du résumé

BACKGROUND BACKGROUND
Esophagectomy is associated with significant mortality. A better understanding of the causes leading to death may help to reduce mortality. A root cause analysis of mortality after esophagectomy was performed.
METHODS METHODS
Root cause analysis was retrospectively applied by an independent expert panel of 4 upper gastrointestinal surgeons and 1 anesthesiologist-intensivist to patients included in the French national multicenter prospective cohort FREGAT between August 2014 and September 2019 who underwent an esophagectomy for cancer and died within 90 days of surgery. A cause-and-effect diagram was used to determine the root causes related to death. Death was classified as potentially preventable or non-preventable.
RESULTS RESULTS
Among the 1,040 patients included in the FREGAT cohort, 70 (6.7%) patients (male: 81%, median age 68 [62-72] years) from 17 centers were included. Death was potentially preventable in 37 patients (53%). Root causes independently associated with preventable death were inappropriate indication (odds ratio 35.16 [2.50-494.39]; P = .008), patient characteristics (odds ratio 5.15 [1.19-22.35]; P = .029), unexpected intraoperative findings (odds ratio 18.99 [1.07-335.55]; P = .045), and delay in diagnosis of a complication (odds ratio 98.10 [6.24-1,541.04]; P = .001). Delay in treatment of a complication was found only in preventable deaths (28 [76%] vs 0; P < .001). National guidelines were less frequently followed (16 [43%] vs 22 [67%]; P = .050) in preventable deaths. The only independent risk factor of preventable death was center volume <26 esophagectomies per year (odds ratio 4.71 [1.55-14.33]; P = .006).
CONCLUSIONS CONCLUSIONS
More than one-half of deaths after esophagectomy were potentially preventable. Better patient selection, early diagnosis, and adequate management of complications through centralization could reduce mortality.

Identifiants

DOI: 10.1016/j.surg.2024.03.012 PMID: 38641545
pubmed: 38641545
pii: S0039-6060(24)00149-1
doi: 10.1016/j.surg.2024.03.012
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Elsevier Inc. All rights reserved.

Auteurs

Guillaume Levenson (G)

Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Paris, France; Université Paris Cité, Paris, France. Electronic address: guillaume.levenson@aphp.fr.

Maxime Coutrot (M)

Université Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Département d'anesthésie réanimation et centre de traitement des brûlés, Paris, France.

Thibault Voron (T)

Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Chirurgie Générale et Digestive, Paris, France; Sorbonne Université, Paris, France. Electronic address: https://www.twitter.com/ThibaultVORON.

Caroline Gronnier (C)

Unité de Chirurgie Œsogastrique et Endocrinienne, Service de Chirurgie Digestive et Endocrinienne, Centre Médico-Chirurgical Magellan, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France; Faculté de Médecine, Université Bordeaux-Segalen, Bordeaux, France.

Pierre Cattan (P)

Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Paris, France; Université Paris Cité, Paris, France.

Christian Hobeika (C)

Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, APHP, Clichy, Paris-Cité University, Paris, France; UMR Inserm 1275 CAP Paris-Tech, Lariboisière Hospital, Paris, Paris-Cité University, Paris, France.

Xavier Benoît D'Journo (XB)

Department of Thoracic Surgery, Aix-Marseille University, North Hospital, Marseille, France.

Damien Bergeat (D)

Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire (CHU Rennes), Université de Rennes 1 Centre, Rennes, France.

Olivier Glehen (O)

Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France.

Muriel Mathonnet (M)

Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, France.

Guillaume Piessen (G)

Centre Hospitalo-Universitaire Lille, Service de Chirurgie Digestive et Oncologique, Lille, France; University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer, Heterogeneity Plasticity and Resistance to Therapies, Lille, France. Electronic address: https://www.twitter.com/PiessenG.

Diane Goéré (D)

Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Paris, France; Université Paris Cité, Paris, France.

Classifications MeSH