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Association of Sarcopenia and Low Nutritional Status with Unplanned Hospital Readmission after Radical Gastrectomy in Patients with Gastric Cancer: A Case-Control Study. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7246848. [PMID: 35463676 PMCID: PMC9033374 DOI: 10.1155/2022/7246848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
Objective. Sarcopenia is one of the influencing factors of poor prognosis in patients with gastric cancer but the association with readmission are unknown. We aimed to explore factors associated with readmission after gastrectomy and to determine whether preoperative sarcopenia is a common outcome in readmitted patients. Methods. In this case-control study, patients who underwent gastric resection in the First Affiliated Hospital of Wenzhou Medical University between April 2016 and September 2017 were included. The reasons of readmission patients were described. The readmission patients and non-readmission patients were matched by propensity score matching (PSM). The univariate analysis was applied for the baseline characteristics, operative details, postoperative prognosis and discharge disposition, and multiple logistic regression analysis for the independent risk factors of readmission. Results. The unplanned readmission rate within 30 days of radical gastrectomy for gastric cancer was 6.5% (43/657). The average time interval from discharge to readmission was 13 days. Delayed gastric evacuation was the main cause of readmission (18.6%, 8/43). Body mass index (BMI), nutritional risk screening (NRS) 2002 score, history of abdominal surgery, sarcopenia, and preoperative albumin were included in the multivariate logistic regression analysis. NRS 2002 (OR = 3.43, 95% CI: 1.10–10.72,
) and sarcopenia (OR = 4.25, 95% CI: 1.13–16.02,
) were found to be independently associated with unplanned readmission within 30 days of radical gastrectomy for cancer. Other factors such as age, sex, BMI, American Society of Anesthesiologists grade, surgical method, operation and reconstruction type, TNM stage, surgical duration, previous abdominal surgery, and preoperative albumin and hemoglobin level were not associated with unplanned readmission after radical gastrectomy for cancer. Conclusions. Sarcopenia and low nutritional status are independently associated with unplanned readmission within 30 days of radical gastrectomy for cancer.
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Tamburini N, Dalmonte G, Petrarulo F, Valente M, Franchini M, Valpiani G, Resta G, Cavallesco G, Marchesi F, Anania G. Analysis of Rates, Causes, and Risk Factors for 90-Day Readmission After Surgery for Large Hiatal Hernia: A Two-Center Study. J Laparoendosc Adv Surg Tech A 2022; 32:459-465. [PMID: 35179391 DOI: 10.1089/lap.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Hospital readmissions have become a more examined indicator of surgical care delivery and quality. There is scarcity of data in the literature on the rate, risk factors, and most common reasons of readmission following major hiatal hernia surgery. The primary endpoint was 90-day readmission after surgery for large hiatal hernia. Secondary endpoint was to examine which characteristics related with a higher risk of readmission. Methods: A retrospective review of two distinct institutional databases was performed for patients who had surgery for a large hiatal hernia between January 2012 and December 2019. Demographic, perioperative, and outpatient data were collected from the medical record. Results: A total of 71 patients met the inclusion criteria, most of them suffering from a type III hernia (66.2%). Mean operative time was 146 (±56.5) minutes and median length of stay (LOS) was 6 days (interquartile range = 3). The overall morbidity was 21.1% and the in-hospital mortality was 1.4%. The 30- and 90-day readmission rates were 7% and 8.5%, respectively. The mean time to readmission was 14.3 (±15.6) days. The reasons for 90-day hospital readmission were dysphagia (50%), pneumonia (16.7%), congestive heart failure (16.7%), and bowel obstruction (16.7%). Grade of esophagitis ≥2, presence of Barrett's esophagus, and LOS longer than 8 days were significant risk factors for unplanned readmission within 90 days. Conclusion: We observed that about 6 out of 71 patients who had surgery readmitted within 90 days (8.5%). Readmissions were most often linked to esophagitis ≥2, presence of Barrett's esophagus, and LOS longer than 8 days. These findings point to the necessity for focused treatments before, during, and after hospitalization to decrease morbidity and extra costs in this high-risk population.
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Affiliation(s)
- Nicola Tamburini
- Department of Surgery, Section of Chirurgia 1, Sant'Anna University Hospital of Ferrara, Cona, Italy.,Research Innovation Quality and Accreditation Unit, Sant'Anna University Hospital of Ferrara, Cona, Italy
| | - Giorgio Dalmonte
- Unit of General Surgery, Parma University Hospital, University of Parma, Parma, Italy
| | - Francesca Petrarulo
- Department of Surgery, Section of Chirurgia 1, Sant'Anna University Hospital of Ferrara, Cona, Italy.,Research Innovation Quality and Accreditation Unit, Sant'Anna University Hospital of Ferrara, Cona, Italy
| | - Marina Valente
- Unit of General Surgery, Parma University Hospital, University of Parma, Parma, Italy
| | - Matteo Franchini
- Unit of General Surgery, Parma University Hospital, University of Parma, Parma, Italy
| | - Giorgia Valpiani
- Research Innovation Quality and Accreditation Unit, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Giuseppe Resta
- Department of Surgery, Section of Chirurgia 1, Sant'Anna University Hospital of Ferrara, Cona, Italy.,Research Innovation Quality and Accreditation Unit, Sant'Anna University Hospital of Ferrara, Cona, Italy
| | - Giorgio Cavallesco
- Department of Surgery, Section of Chirurgia 1, Sant'Anna University Hospital of Ferrara, Cona, Italy.,Research Innovation Quality and Accreditation Unit, Sant'Anna University Hospital of Ferrara, Cona, Italy
| | - Federico Marchesi
- Unit of General Surgery, Parma University Hospital, University of Parma, Parma, Italy
| | - Gabriele Anania
- Department of Surgery, Section of Chirurgia 1, Sant'Anna University Hospital of Ferrara, Cona, Italy.,Research Innovation Quality and Accreditation Unit, Sant'Anna University Hospital of Ferrara, Cona, Italy
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3
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Osaki T, Saito H, Miyauchi W, Shishido Y, Miyatani K, Matsunaga T, Tatebe S, Fujiwara Y. The type of gastrectomy and modified frailty index as useful predictive indicators for 1-year readmission due to nutritional difficulty in patients who undergo gastrectomy for gastric cancer. BMC Surg 2021; 21:445. [PMID: 34965862 PMCID: PMC8715605 DOI: 10.1186/s12893-021-01450-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 12/17/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients who undergo gastrectomy for gastric cancer (GC) are likely to have nutritional difficulty after surgery. Readmission due to nutritional difficulty is common in such patients. Thus, in this study, we aim to identify the predictive indicators for readmission due to nutritional difficulty in patients who underwent gastrectomy for GC. METHODS We retrospectively reviewed surgical outcomes in 516 consecutive patients who underwent gastrectomy for GC. RESULTS The readmission rate within 1 year was 13.8%. Readmission due to nutritional difficulty was observed in 20 patients (3.9%); it was determined as the second leading cause of readmission. Multivariate analysis revealed that the type of gastrectomy and the modified frailty index (mFI) were independent predictive indicators of readmission due to nutritional difficulty. Patients were assigned 1 point for each predictive indicator, and the total points were calculated (point 0, point 1, or point 2). The readmission rates due to nutritional difficulty were 1.2%, 4.7%, and 11.5% in patients with 0, 1, and 2 points, respectively (P = 0.0008). CONCLUSIONS The readmission rate due to nutritional difficulty was noted to be high in patients who underwent total or proximal partial gastrectomy with high mFI. Intensive follow-up and nutritional support are needed to reduce readmissions due to nutritional difficulty. Reduced readmission rates can improve patient quality of life and reduce medical costs.
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Affiliation(s)
- Tomohiro Osaki
- Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, 680-0901, Japan
| | - Hiroaki Saito
- Department of Surgery, Japanese Red Cross Tottori Hospital, 117 Shotoku-cho, Tottori, 680-8571, Japan.
| | - Wataru Miyauchi
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Shigeru Tatebe
- Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, 680-0901, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
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Roh CK, Son SY, Lee SY, Hur H, Han SU. Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single-center phase II clinical trial for safety and efficacy. J Surg Oncol 2020; 121:662-669. [PMID: 31930513 DOI: 10.1002/jso.25837] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/02/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND We aimed to evaluate the safety and efficacy of a clinical pathway (CP) for enhanced recovery after surgery (ERAS) in gastric cancer patients, including early oral feeding and discharge on postoperative day 4. METHODS We performed a prospective, single-center, phase II clinical trial. Based on proposed indications for an ERAS CP in our retrospective study, we enrolled 133 patients younger than 65 years who were undergoing minimally invasive subtotal gastrectomy. The primary endpoint was the ERAS CP completion rate. Secondary endpoints included complication, mortality, hospital stay, and readmission. RESULTS Among 133 patients, six patients were dropped out from this study. The ERAS CP completion rate (77.2%, 98 of 127) was comparable to the historical control group that completed a conventional CP (85.4%, P = .085). The postoperative complication incidence (13.4%, 15 of 127) was also similar to that of the conventional CP group (9.5%, P = .174). We identified reduced hospital stays (4.7 ± 1.3 vs 7.2±2.3 days; P < .001) and lower hospital costs ($7771 vs 8539; P < .001) in the ERAS CP group compared with the conventional CP group. CONCLUSIONS An ERAS CP can be safely and effectively adopted for patients with gastric cancer without increasing the complication rate and could shorten hospital stays. TRIAL REGISTRATION ClinicalTrials.gov (NCT01642953).
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Affiliation(s)
- Chul Kyu Roh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sook Young Lee
- Department of Anesthesiology, Ajou University School of Medicine, Suwon, Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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5
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Dan Z, YiNan D, ZengXi Y, XiChen W, JieBin P, LanNing Y. Thirty-Day Readmission After Radical Gastrectomy for Gastric Cancer: A Meta-analysis. J Surg Res 2019; 243:180-188. [DOI: 10.1016/j.jss.2019.04.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/12/2019] [Accepted: 04/25/2019] [Indexed: 01/03/2023]
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6
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Zafar SN, Shah AA, Nembhard C, Wilson LL, Habermann EB, Raoof M, Wasif N. Readmissions After Complex Cancer Surgery: Analysis of the Nationwide Readmissions Database. J Oncol Pract 2019; 14:e335-e345. [PMID: 29894662 DOI: 10.1200/jop.17.00067] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Hospital readmissions after surgery are a focus of quality improvement efforts. Although some reflect appropriate care, others are potentially preventable readmissions (PPRs). We aim to describe the burden, timing, and factors associated with readmissions after complex cancer surgery. METHODS The Nationwide Readmissions Database (2013) was used to select patients undergoing a complex oncologic resection, which was defined as esophagectomy/gastrectomy, hepatectomy, pancreatectomy, colorectal resection, lung resection, or cystectomy. Readmissions within 30 days from discharge were analyzed. International Classification of Diseases (9th revision) primary diagnosis codes were reviewed to identify PPRs. Multivariable logistic regression analyses identified demographic, clinical, and hospital factors associated with readmissions. RESULTS Of the 59,493 eligible patients, 14% experienced a 30-day readmission, and 82% of these were deemed PPRs. Half of the readmissions occurred within the first 8 days of discharge. Infections (26%), GI complications (17%), and respiratory conditions (10%) accounted for most readmissions. Factors independently associated with an increased likelihood of readmission included Medicaid versus private insurance (odds ratio [OR], 1.32; 95% CI, 1.17 to 1.48), higher comorbidity score (OR, 1.5; 95% CI, 1.33 to 1.63), discharge to a facility (OR, 1.39; 95% CI, 1.29 to 1.51), prolonged length of stay (OR, 1.42; 95% CI, 1.32 to 1.52), and occurrence of a major in-hospital complication (OR, 1.24; 95% CI, 1.16 to 1.34). CONCLUSION One in seven patients undergoing complex cancer surgery suffered a readmission within 30 days. We identified common causes of these and identified patients at high risk for such an event. These data can be used by physicians, administrators, and policymakers to develop strategies to decrease readmissions.
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Affiliation(s)
- Syed Nabeel Zafar
- University of Maryland, Baltimore, MD; Howard University Hospital, Washington, DC; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, AZ; and City of Hope National Medical Center, Duarte CA
| | - Adil A Shah
- University of Maryland, Baltimore, MD; Howard University Hospital, Washington, DC; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, AZ; and City of Hope National Medical Center, Duarte CA
| | - Christine Nembhard
- University of Maryland, Baltimore, MD; Howard University Hospital, Washington, DC; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, AZ; and City of Hope National Medical Center, Duarte CA
| | - Lori L Wilson
- University of Maryland, Baltimore, MD; Howard University Hospital, Washington, DC; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, AZ; and City of Hope National Medical Center, Duarte CA
| | - Elizabeth B Habermann
- University of Maryland, Baltimore, MD; Howard University Hospital, Washington, DC; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, AZ; and City of Hope National Medical Center, Duarte CA
| | - Mustafa Raoof
- University of Maryland, Baltimore, MD; Howard University Hospital, Washington, DC; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, AZ; and City of Hope National Medical Center, Duarte CA
| | - Nabil Wasif
- University of Maryland, Baltimore, MD; Howard University Hospital, Washington, DC; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Arizona, Phoenix, AZ; and City of Hope National Medical Center, Duarte CA
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7
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Wu WW, Zhang WH, Zhang WY, Yang L, Deng XQ, Zhu T. Risk factors of the postoperative 30-day readmission of gastric cancer surgery after discharge: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14639. [PMID: 30855450 PMCID: PMC6417637 DOI: 10.1097/md.0000000000014639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Readmission is a common postoperative adverse event. This study aimed to analyze potential risk factors for the incidence of postoperative 30-day readmission after discharge for gastric cancer patients with surgical treatment. METHODS Those studies that reported the risk factors of gastric cancer patients who have a postoperative 30-day readmission were identified systematically from the PubMed, Cochrane, and Embase databases through July 2018. A systematic review and meta-analysis was performed to estimate the risk factors of postoperative 30-day readmission after gastric cancer surgery. RESULTS Ultimately, 6 studies with 12,586 gastric cancer patients were included in the present study. There were 1473 (11.7%) patients who had postoperative 30-day readmission and 12,586 (88.3%) patients without 30-day postoperative readmission. A greater proportion of the readmission group had cardiovascular comorbidity (P < .001), pulmonary comorbidity (P < .001), and diabetes mellitus (P = .020) than the nonreadmission group. Furthermore, more patients in the readmission group had total gastrectomy (P < .001), combined organ resection (P < .001) and postoperative complications (P < .001) than did patients in the nonreadmission group. Nonhome discharge (odds ratio [OR] 1.580, P = .002), diabetes mellitus (OR 1.181, P = .044), postoperative complications (OR 2.656, P = .006), total gastrectomy (OR 2.242, P < .001), and combined organ resection (OR 1.534, P < .001) were independent risk factors for postoperative readmission. CONCLUSION Postoperative readmission is influenced by the synthetic action of preparative, intraoperative, and postoperative factors, such as diabetes mellitus, total gastrectomy, combined organ resection, nonhome discharge, and postoperative complications. Extra attention should be paid to those patients with high risk factors during the postoperative follow-up and recovery periods.
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Affiliation(s)
- Wei-Wei Wu
- Department of Anesthesiology, West China Hospital
| | - Wei-Han Zhang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Collaborative Innovation Center for Biotherapy, Sichuan University, Chengdu, China
| | - Wei-Yi Zhang
- Department of Anesthesiology, West China Hospital
| | - Lei Yang
- Department of Anesthesiology, West China Hospital
| | | | - Tao Zhu
- Department of Anesthesiology, West China Hospital
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Incidence, causes and risk factors for 30-day readmission after radical gastrectomy for gastric cancer: a retrospective study of 2,023 patients. Sci Rep 2018; 8:10582. [PMID: 30002486 PMCID: PMC6043555 DOI: 10.1038/s41598-018-28850-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/28/2018] [Indexed: 02/07/2023] Open
Abstract
The aim of this retrospective study was to investigate the incidence of, causes and risk factors for readmission to hospital ≤30 days after discharge of patients who underwent radical gastrectomy for gastric cancer. A total of 2,023 patients underwent radical gastrectomy operations from November 2010 to July 2017 in our hospital. Of these, 60 patients (3.0%) were readmitted within 30 days after their original discharge. The median time span between the index discharge and readmission was 14 days and the median time for readmission was 8 days. The main reasons for readmission were intestinal obstruction (n = 10, 16.7%), intra-abdominal fluid collection (n = 9, 15.0%), abdominal pain (n = 7, 11.7%), nutritional difficulty (n = 4, 6.7%) and anastomotic leakage (n = 4, 6.7%). Five patients (8.3%) required intensive care and 4 patients (6.7%) died from sudden cardiac arrest, gastrointestinal bleeding, sepsis or multiple organ dysfunctions. Multivariate analysis revealed that post-operative complications (Odds Ratio = 5.116, 95% confidence interval: 2.885–9.073, P < 0.001) was the only independent risk factor for readmission. Thus, appropriate strategies on discharge and close follow-ups for these high-risk patients should be drawn up in order to enhance significantly their quality of care.
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9
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Jung MR, Ryu SY, Park YK, Jeong O. Compliance with an Enhanced Recovery After a Surgery Program for Patients Undergoing Gastrectomy for Gastric Carcinoma: A Phase 2 Study. Ann Surg Oncol 2018; 25:2366-2373. [PMID: 29789971 DOI: 10.1245/s10434-018-6524-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs have gained widespread acceptance in different fields of major surgery. However, most elements of perioperative care in ERAS are based on practices that originated from colorectal surgery. This study investigated compliance with the main elements of ERAS for patients undergoing gastrectomy for gastric carcinoma. METHODS This phase 2 study enrolled 168 patients undergoing elective gastrectomy for gastric carcinoma. An ERAS program consisting of 18 main elements was implemented, and compliance with each element was evaluated (ClinicalTrials.gov, NCT01653496). RESULTS Distal gastrectomy was performed for 142 patients (84.5%) and total gastrectomy for 26 patients (10.1%). Laparoscopic surgery was performed for 141 patients (86%). The postoperative morbidity rate was 9.5%, and the mortality rate was 0%. The rates of compliance with the 18 main elements of ERAS ranged from 88.1 to 100%. The lowest compliance rate was observed in the restriction of intravenous fluid element (88.1%). Overall, all ERAS elements were successfully applied for 122 patients (72.6%). In the multivariate analysis, the significant factors that adversely affected compliance with ERAS were surgery during the early study period [odds ratio (OR) 0.39; p = 0.038], open surgery (OR 0.15; p <0.001), and postoperative morbidity (OR 0.16; p = 0.003). CONCLUSIONS Most elements of ERAS can be successfully applied for patients undergoing gastrectomy for gastric carcinoma. Multimodal collaboration between providers is essential to achieve proper application of ERAS.
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Affiliation(s)
- Mi Ran Jung
- Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea.,Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea
| | - Seong Yeob Ryu
- Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea.,Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea
| | - Young Kyu Park
- Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea.,Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea
| | - Oh Jeong
- Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea. .,Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea.
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10
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Predictors of 30-day readmissions after gastrectomy for malignancy. J Surg Res 2018; 224:176-184. [PMID: 29506837 DOI: 10.1016/j.jss.2017.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/03/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of this study is to identify risk factors associated with readmission after gastrectomy to potentially identify potential areas for targeted improvements. Hospital readmission after surgery is a topic of interest in health-care policy among hospitals, payers, and providers. Readmissions are associated with increased costs, morbidity, and mortality. Readmission rates have been proposed as a quality metric for hospitals and quality indicator of individual surgeon's performance. In addition, the Centers for Medicare and Medicaid Services has reduced payments to hospitals with excessive readmissions for certain diagnoses. MATERIALS AND METHODS All gastrectomy procedures for malignancy in patients aged ≥18 y from 2005 to 2011 were queried from the California State Inpatient Database. Patients who died during index admission were excluded. Descriptive statistics were examined between all baseline variables and readmission status. Logistic regression models were adjusted for age, race, sex, and insurance status. RESULTS A total of 6985 patients underwent gastrectomy for malignancy; 16.5% of the patients were readmitted after postoperative discharge. Readmission rate did not change significantly over time. Multivariable analysis demonstrated that the occurrence of any postoperative complications, postoperative length of stay greater than 10 d, discharge to skilled nursing facility or home health care, combined resection with distal pancreatectomy and/or splenectomy, and patient comorbidities like diabetes mellitus and renal failure were independently associated with readmissions. CONCLUSIONS The findings suggest that focusing on quality improvement efforts by targeting reduction of postoperative complications may reduce readmission rates.
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11
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Choe YR, Joh JY, Kim YP. Association between frailty and readmission within one year after gastrectomy in older patients with gastric cancer. J Geriatr Oncol 2017; 8:185-189. [PMID: 28259489 DOI: 10.1016/j.jgo.2017.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/25/2016] [Accepted: 02/07/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The incidence of gastric cancer in older people is increasing. Because older patients are at increased risk of postoperative complications and mortality, preoperative risk assessment in this population is important. This study explored whether preoperative assessment of frailty could be useful for predicting the postoperative outcome in patients with gastric cancer. MATERIALS AND METHODS We investigated 223 patients (136 men and 87 women) over 65years of age who underwent gastric cancer surgery from April 2012 to March 2015 at a single institution in Korea. Frailty was assessed using the Study of Osteoporotic Fractures (SOF) frailty index. Logistic regression was used to identify factors predicting readmission within one year of discharge following gastrectomy. RESULTS Twenty six (11.7%) patients were readmitted within one year after gastrectomy. Patients in the "robust" and "pre-frail and frail" group had a readmission rate of 6.7% and 19.1%, respectively. After adjusting age, gender, Eastern Cooperative Oncology Group performance status (ECOG PS) (score≥1), histological type and stage (III, IV), frailty (pre-frail and frail) was a predictive factor for readmission within one year of discharge after gastrectomy (Odds Ratio, 5.74, 95%; Confidence Interval, 1.78-18.48; p=0.003). CONCLUSIONS Preoperative risk assessment including frailty evaluation can predict the readmission within one year of discharge after gastrectomy. Frailty assessment can help physicians to identify the risk and inform patients and their families of the risk, which should improve decision making in gastric cancer treatment.
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Affiliation(s)
- Yu-Ri Choe
- Department of Family Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Chonnam, South Korea.
| | - Ju-Youn Joh
- Department of Family Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Chonnam, South Korea.
| | - Yeon-Pyo Kim
- Department of Family Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Chonnam, South Korea; Chonnam National University School of Medicine, 160, Baekseo-ro, Dong-gu, Gwangju, South Korea.
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12
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Kong L, Yang N, Shi L, Zhao G, Wang M, Zhang Y. Total versus subtotal gastrectomy for distal gastric cancer: meta-analysis of randomized clinical trials. Onco Targets Ther 2016; 9:6795-6800. [PMID: 27853375 PMCID: PMC5106238 DOI: 10.2147/ott.s110828] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives This meta-analysis of randomized controlled trials was conducted to give a more precise estimation of the efficacy and drawbacks of total gastrectomy (TG) versus subtotal gastrectomy (SG) for proven distal gastric cancer. Methods The electronic databases Cochrane and PubMed (updated on April 10, 2016) were searched for randomized controlled trials comparing TG with SG as surgical procedures for distal gastric cancer. Five outcome variables were analyzed, including postoperative complications, anastomotic fistula rate, hospital mortality rate, mortality rate of recurrence (the patient’s death is caused by the recurrence of gastric cancer, rather than caused by other diseases), and 5-year survival rate. Random or fixed effect model was used to perform this meta-analysis. Results Six trials, including 573 cases treated with TG and 791 cases treated with SG, were included. Compared with patients in the SG group, patients in the TG group did not show a higher rate of postoperative complications (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.71–3.03, P=0.30). However, patients in the TG group showed a significantly higher rate of anastomotic fistula than patients in the SG group (OR: 3.78, 95% CI: 1.97–7.27, P<0.0001). Hospital mortality rate, which was analyzed in four trials, including 510 TG versus 729 SG patients, showed no significant difference between the two groups (OR: 1.80, 95% CI: 0.85–3.78, P=0.12). Importantly, there was no significant difference in the 5-year survival between the two groups (OR: 0.68, 95% CI: 0.39–1.19, P=0.18). Mortality rate of recurrence, which was also analyzed in three trials, including 396 TG versus 407 SG patients, showed a significantly higher rate in the TG group (OR: 0.07, 95% CI: 0.01–0.13, P=0.03). Conclusion This meta-analysis demonstrated that postoperative complications, hospital mortality rate, and 5-year survival rate in TG patients was similar to the SG group. Furthermore, SG was associated with significantly fewer anastomotic fistula and lower mortality rate of recurrence compared with TG. However, lower mortality rate of recurrence was probably related to the criteria of these two procedures.
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Affiliation(s)
- Lingling Kong
- Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Nianzhao Yang
- Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Lianghui Shi
- Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Guohai Zhao
- Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Minghai Wang
- Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Yisheng Zhang
- Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
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13
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Martin AN, Das D, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM. Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors. J Gastrointest Surg 2016; 20:1554-64. [PMID: 27364726 PMCID: PMC4987171 DOI: 10.1007/s11605-016-3195-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/20/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy. METHODS This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission, and reoperation. RESULTS Three thousand six hundred and seventy-eight patients underwent gastrectomy. A majority of patients had distal gastrectomy (N = 2,799, 76.1 %) and had resection for malignancy (N = 2,316, 63.0 %). Seven hundred and ninety-eight patients (21.7 %) experienced a major complication. Reoperation was required in 290 patients (7.9 %). Thirty-day mortality was 5.2 %. Age (OR = 1.01, 95 % CI = 1.01-1.02, p = 0.001), preoperative malnutrition (OR = 1.65, 95 % CI = 1.35-2.02, p < 0.001), total gastrectomy (OR = 1.63, 95 % CI = 1.31-2.03, p < 0.001), benign indication for resection (OR = 1.60, 95 % CI = 1.29-1.97, p < 0.001), blood transfusion (OR = 2.57, 95 % CI = 2.10-3.13, p < 0.001), and intraoperative placement of a feeding tubes (OR = 1.28, 95 % CI = 1.00-1.62, p = 0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR = 1.23, 95 % CI = 0.99-1.53, p = 0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p < 0.001). CONCLUSIONS Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.
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Affiliation(s)
- Allison N. Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia,Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA
| | - Deepanjana Das
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Florence E. Turrentine
- Department of Surgery, University of Virginia, Charlottesville, Virginia,Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA
| | - Todd W. Bauer
- Department of Surgery, University of Virginia, Charlottesville, Virginia,Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, Virginia
| | - Reid B. Adams
- Department of Surgery, University of Virginia, Charlottesville, Virginia,Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, Virginia
| | - Victor M. Zaydfudim
- Department of Surgery, University of Virginia, Charlottesville, Virginia,Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, Virginia,Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA
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14
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Acher AW, Squires MH, Fields RC, Poultsides GA, Schmidt C, Votanopoulos KI, Pawlik TM, Jin LX, Ejaz A, Kooby DA, Bloomston M, Worhunsky D, Levine EA, Saunders N, Winslow E, Cho CS, Leverson G, Maithel SK, Weber SM. Readmission Following Gastric Cancer Resection: Risk Factors and Survival. J Gastrointest Surg 2016; 20:1284-94. [PMID: 27102802 DOI: 10.1007/s11605-015-3070-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/29/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study utilized a multi-institutional database to evaluate risk factors for readmission in patients undergoing curative gastrectomy for gastric adenocarcinoma with the intent of describing both perioperative risk factors and the relationship of readmission to survival. METHODS Patients who underwent curative resection of gastric adenocarcinoma from 2000 to 2012 from seven academic institutions of the US Gastric Cancer Collaborative were analyzed. In-hospital deaths and palliative surgeries were excluded, and readmission was defined as within 30 days of discharge. Univariate and multivariable logistic regression analyses were employed and survival analysis conducted. RESULTS Of the 855 patients, 121 patients (14.2 %) were readmitted. Univariate analysis identified advanced age (p < 0.0128), American Society of Anesthesiology status ≥3 (p = 0.0045), preexisting cardiac disease (p < 0.0001), hypertension (p = 0.0142), history of smoking (p = 0.0254), increased preoperative blood urea nitrogen (BUN; p = 0.0426), concomitant pancreatectomy (p = 0.0056), increased operation time (p = 0.0384), estimated blood loss (p = 0.0196), 25th percentile length of stay (<7 days, p = 0.0166), 75th percentile length of stay (>12 days, p = 0.0256), postoperative complication (p < 0.0001), and total gastrectomy (p = 0.0167) as risk factors for readmission. Multivariable analysis identified cardiac disease (odds ratio (OR) 2.4, 95 % confidence interval (CI) 1.6-3.3, p < 0.0001), postoperative complication (OR 2.3, 95 % CI 1.6-5.4, p < 0.0001), and pancreatectomy (OR 2.2, 95 % CI 1.1-4.1, p = 0.0202) as independent risk factors for readmission. There was an association of decreased overall median survival in readmitted patients (39 months for readmitted vs. 103 months for non-readmitted). This was due to decreased survival in readmitted stage 1 (p = 0.0039), while there was no difference in survival for other stages. Stage I readmitted patients had a higher incidence of cardiac disease than stage I non-readmitted patients (58 vs. 24 %, respectively, p = 0.0002). CONCLUSIONS Within this multi-institutional study investigating readmission in patients undergoing curative resection for gastric cancer, cardiac disease, postoperative complication, and concomitant pancreatectomy were identified as significant risk factors for readmission. Readmission was associated with decreased overall median survival, but on further analysis, this was driven by differences in survival for stage I disease only.
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Affiliation(s)
- Alexandra W Acher
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Ryan C Fields
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | | | - Linda X Jin
- Washington University School of Medicine, St. Louis, MO, USA
| | - Aslam Ejaz
- The Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | - Emily Winslow
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Clifford S Cho
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Glen Leverson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Sharon M Weber
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Department of General Surgery, H4/730, 7375 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA.
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15
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Merchant SJ, Ituarte PHG, Choi A, Sun V, Chao J, Lee B, Kim J. Hospital Readmission Following Surgery for Gastric Cancer: Frequency, Timing, Etiologies, and Survival. J Gastrointest Surg 2015; 19:1769-81. [PMID: 26162924 DOI: 10.1007/s11605-015-2883-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/23/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Readmission rates after cancer surgery are infrequently reported, and better understanding of the etiologies for readmission is necessary. We sought to investigate the frequency, timing, and etiologies for hospital readmission after surgery for gastric cancer and whether readmission correlates with clinical outcomes. STUDY DESIGN Hospital readmission was examined through linkage of the California Cancer Registry with the Office of Statewide Health Planning and Development database. Patients with gastric adenocarcinoma who had undergone curative intent surgery between 2000 and 2011 were identified. First readmission within 90 days of initial surgery was analyzed with respect to timing (0-30, 31-60, and 61-90 days) and etiology for readmission. Variables associated with readmission and impact on 5-year overall survival (OS) were examined. RESULTS A total of 8887 (male, n = 5326; female, n = 3561) patients underwent curative intent surgery for gastric adenocarcinoma. Within 90 days of initial surgery, 2559 (28.8 %) patients had inpatient hospital readmission. The majority of readmissions occurred in the first 30 days [0-30, n = 1371 (53.6 %); 31-60, n = 773 (30.2 %); and 61-90, n = 415 (16.2 %)]. Readmission vs. no readmission within 90 days correlated with worse 5-year OS in patients with local (51.2 vs. 70.9 %, p < 0.0001) and regional (23.3 vs. 32.9 %, p < 0.0001) disease. On multivariate analysis, readmission within 90 days was associated with worse OS (HR 1.40, 95 % CI 1.32-1.49, p < 0.001). CONCLUSIONS Hospital readmissions are high after surgery for gastric cancer and correlate with poor patient survival. A better understanding of these issues may allow health care providers to potentially lower readmission rates and improve gastric cancer outcomes.
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Affiliation(s)
- Shaila J Merchant
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Philip H G Ituarte
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Audrey Choi
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Virginia Sun
- Nursing Research and Education, City of Hope National Medical Center, Duarte, CA, USA
| | - Joseph Chao
- Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Byrne Lee
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Joseph Kim
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
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16
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Zhuang CL, Wang SL, Huang DD, Pang WY, Lou N, Chen BC, Chen XL, Yu Z, Shen X. Risk factors for hospital readmission after radical gastrectomy for gastric cancer: a prospective study. PLoS One 2015; 10:e0125572. [PMID: 25915547 PMCID: PMC4410937 DOI: 10.1371/journal.pone.0125572] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/24/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Hospital readmission is gathering increasing attention as a measure of health care quality and a potential cost-saving target. The purpose of this prospective study was to determine risk factors for readmission within 30 days of discharge after gastrectomy for patients with gastric cancer. METHODS We conducted a prospective study of patients undergoing radical gastrectomy for gastric cancer from October 2013 to November 2014 in our institution. The incidence, cause and risk factors for 30-day readmission were determined. RESULTS A total of 376 patients were included in our analysis without loss in follow-up. The 30-day readmission rate after radical gastrectomy for gastric cancer was 7.2% (27of 376). The most common cause for readmission included gastrointestinal complications and postoperative infections. On the basis of multivariate logistic regression analysis, preoperative nutritional risk screening 2002 score ≥ 3 was an independent risk factor for 30-day readmission. Factors not associated with a higher readmission rate included a history of a major postoperative complication during the index hospitalization, prolonged primary length of hospital stay after surgery, a history of previous abdominal surgery, advanced age, body mass index, pre-existing cardiopulmonary comorbidities, American Society of Anesthesiology grade, type of resection, extent of node dissection and discharge disposition. CONCLUSIONS Readmission within 30 days of discharge after radical gastrectomy for gastric cancer is common. Patients with nutritional risk preoperatively are at high risk for 30-day readmission. Preoperative optimization of nutritional status of patients at nutritional risk may effectively decrease readmission rates.
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Affiliation(s)
- Cheng-Le Zhuang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Su-Lin Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Dong-Dong Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wen-Yang Pang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Neng Lou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bi-Cheng Chen
- Wenzhou Key Laboratory of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Lei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhen Yu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Gastrointestinal Surgery, Shanghai Tenth People’s Hospital Affiliated to Tongji University, Shanghai, China
- * E-mail: (ZY); (XS)
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- * E-mail: (ZY); (XS)
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17
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Jeong O, Kyu Park Y, Ran Jung M, Yeop Ryu S. Analysis of 30-day postdischarge morbidity and readmission after radical gastrectomy for gastric carcinoma: a single-center study of 2107 patients with prospective data. Medicine (Baltimore) 2015; 94:e259. [PMID: 25789945 PMCID: PMC4602494 DOI: 10.1097/md.0000000000000259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PD morbidity and readmission pose a substantial clinical and economic burden to the healthcare system. Comprehensive PD complications and readmission data are essential for developing initiatives to improve patient care. No previous studies have extensively investigated PD complications after gastric cancer surgery.We investigated the incidence, types, treatment, and risk factors of 30-day postdischarge (PD) complications after gastric cancer surgery.Between 2010 and 2013, data concerning complications and readmission within 30 days of hospital discharge were prospectively collected in 2107 patients undergoing gastric cancer surgery.In total, 1642 patients (77.9%) underwent distal gastrectomy, 418 (19.8%) total gastrectomy, and 47 (2.3%) other procedures. Postoperative morbidity and mortality were 17.4% and 0.6%, respectively, with a mean 8.8-day hospital stay. Sixty-one patients (2.9%) developed 30-day PD morbidity (58 local and 3 systemic complications), accounting for 16.6% of overall morbidity; 47 (2.2%) were readmitted; and 7 (0.3%) underwent a reoperation. The mean time to PD complications was 9.5 days after index hospital discharge. The most common complication was intra-abdominal abscess (n = 14), followed by wound, ascites, and anastomosis leakage. No mortality occurred resulting from PD complications. In the univariate and multivariate analyses, underlying comorbidity (hypertension and liver cirrhosis) and obesity were independent risk factors for developing PD complications.The early PD period is a vulnerable time for surgical patients with substantial risk of complication and readmission. Tailored discharge plans along with appropriate PD patient support are essential for improving the quality of patient care.
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Affiliation(s)
- Oh Jeong
- From the Department of Surgery, Chonnam National University Hwasun Hospital, South Korea (OJ, YKP, MRJ, SYR)
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18
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Lee J, Jeon H. The clinical indication and feasibility of the enhanced recovery protocol for curative gastric cancer surgery: analysis of 147 consecutive experiences. Dig Surg 2014; 31:318-23. [PMID: 25402215 DOI: 10.1159/000368091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 09/02/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Radical gastrectomy for gastric cancer is one of the most invasive procedures in gastrointestinal surgery. A few studies have found that an enhanced recovery after surgery (ERAS) protocol is useful in radical gastrectomy. The aim of this study was to evaluate the appropriate indication and feasibility of an ERAS protocol in radical gastrectomy. METHODS We studied the clinical characteristics in 147 patients managed with an ERAS protocol after radical gastrectomy. Of these patients, the protocol was completely applied to 99 (group I), meaning 48 patients (group II) did not complete the protocol. RESULTS The age and ECOG (Eastern Cooperative Oncology Group) status of patients, extent of lymph node dissection, minilaparotomy and insertion of drains were significant influences on compliance to the ERAS protocol. Overall complication rates showed no difference between the two groups; however, local complications were more frequent in group II than group I. Regarding readmission rates within 30 days and after 30 days, there was no significant difference in the incidence and severity grades of causes of readmission between the two groups. CONCLUSIONS The results of this study suggest that an ERAS protocol is feasible and safely applicable without increasing the morbidity and readmission rate after radical gastrectomy if it is applied to patients with positive and less invasive procedures.
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Affiliation(s)
- Junhyun Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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19
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Kim MC, Kim KH, Kim YM, Jung GJ. Comprehension of readmission after laparoscopy assisted distal gastrectomy: what are the causes? Ann Surg Treat Res 2014; 86:237-43. [PMID: 24851224 PMCID: PMC4024929 DOI: 10.4174/astr.2014.86.5.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/14/2014] [Accepted: 02/04/2014] [Indexed: 12/29/2022] Open
Abstract
Purpose The aim of this study is to evaluate long-term outcomes regarding readmission for laparoscopy-assisted distal subtotal gastrectomy (LADG) compared to conventional open distal subtotal gastrectomy (CODG) for early gastric cancer (EGC). Methods Between January 2003 and December 2006, 223 and 106 patients underwent LADG and CODG, respectively, for EGC by one surgeon. The clinicopathologic characteristics, postoperative outcomes, postoperative complications, overall 5-year survival, recurrence, and readmission were retrospectively compared between the two groups. Results Multiple readmission rate in LADG was significantly less than that in CODG (0.4% vs. 3.8%, P = 0.039), although the readmission rate, reoperation rate after discharge, and mean readmission days were not significantly different between the two groups. Readmission rates of the LADG and CODG groups were 12.6% and 14.2%, respectively. First flatus time and postoperative hospital stay was significantly shorter in the LADG group. However, there was no significant difference in the complication rates between the two groups. Overall 5-year survival rates of the LADG and CODG group were 100% and 99.1% (P = 0.038), respectively. Conclusion Compared to the CODG group, the LADG group has several advantages in surgical short-term outcome and some benefit in terms of readmission in surgical long-term outcome for patients with EGC, even though the oncologic outcome of LADG is similar to that of CODG over 5 years.
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Affiliation(s)
- Min-Chan Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Ki-Han Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Yoo-Min Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Ghap-Joong Jung
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
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20
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Ahmad R, Schmidt BH, Rattner DW, Mullen JT. Factors influencing readmission after curative gastrectomy for gastric cancer. J Am Coll Surg 2014; 218:1215-22. [PMID: 24680567 DOI: 10.1016/j.jamcollsurg.2014.02.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/09/2014] [Accepted: 02/10/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND The incidence of, and associated risk factors for, readmission after potentially curative gastrectomy for patients with gastric cancer has not been well studied. We sought to determine the 30-day readmission rate as well as the potential risk factors for readmission at our institution in patients undergoing gastrectomy for gastric cancer with curative intent. STUDY DESIGN We performed a retrospective analysis of all patients undergoing potentially curative gastrectomy for gastric cancer from 1995 to 2011. The 30-day hospital readmission rate was determined, and potential clinicopathologic risk factors for readmission were examined. RESULTS Readmission to the hospital within 30 days occurred in 14.6% (61 of 418) of patients, including 6 patients who were readmitted more than once. The most common reasons for readmission included nutritional difficulties (n =12, 20%), intra-abdominal fluid collections (n = 11, 18%), and small bowel obstruction (n = 6, 10%). Factors associated with a higher 30-day readmission rate included type of resection (total gastrectomy, 23% vs subtotal gastrectomy, 13% vs esophagogastrectomy, 9%, p = 0.016), pre-existing cardiovascular disease (17%, p = 0.05), and history of a major postoperative complication (24%, p < 0.001). Factors not associated with a higher readmission rate included advanced age, pre-existing pulmonary disease, T or N stage, extent of lymph node dissection, receipt of neoadjuvant chemotherapy or radiotherapy, length of stay of the index hospitalization, and destination and level of support on discharge. CONCLUSIONS Readmission after potentially curative gastrectomy for gastric cancer is common. Patients with pre-existing cardiovascular disease, those who suffer major postoperative complications, and those undergoing total gastric resections are at especially high risk for readmission, and strategies designed to support these high-risk patients on discharge are warranted.
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Affiliation(s)
- Rima Ahmad
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - David W Rattner
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, MA.
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21
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Kim YD, Kim MC, Kim KH, Kim YM, Jung GJ. Readmissions following elective radical total gastrectomy for early gastric cancer: a case-controlled study. Int J Surg 2014; 12:200-4. [PMID: 24406263 DOI: 10.1016/j.ijsu.2013.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 12/13/2013] [Accepted: 12/19/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Readmission after gastrectomy is one of the factors that reflect quality of life. Therefore, we analyzed the several factors related to readmissions after total gastrectomy for early gastric cancer. METHODS From January 2002 through December 2009, 102 consecutive patients who underwent radical total gastrectomy for early gastric cancer were enrolled in this study. We evaluated the incidence, cause, time point, and type of treatment for readmission after discharge; we compared the readmission and non-readmission groups in regard to clinicopathologic features and postoperative outcomes. RESULTS The readmission rate during the five years after total gastrectomy was 22 of 102 (21.6%). The most common cause for readmission was esophagojejunostomy stricture (5 cases). The treatment given for 31 readmissions included 23 conservative therapies, 3 radiologic or endoscopic interventions, and 5 re-operations. No significant differences were detected in the clinicopathologic feature, postoperative outcomes, or 5-year survival rates between the readmission and non-readmission group. No specific risk factor was found to be associated with readmission. CONCLUSION Although we could not determine a specific risk factor associated with readmission after radical total gastrectomy, prevention of readmission by evaluating the causes and treatments after radical total gastrectomy can improve the patient's quality of life.
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Affiliation(s)
- Yong-Deok Kim
- Dong-A University College of Medicine, Busan 602-715, Republic of Korea
| | - Min-Chan Kim
- Dong-A University College of Medicine, Busan 602-715, Republic of Korea; Department of Surgery, Dong-A University College of Medicine, Busan 602-715, Republic of Korea.
| | - Ki-Han Kim
- Dong-A University College of Medicine, Busan 602-715, Republic of Korea; Department of Surgery, Dong-A University College of Medicine, Busan 602-715, Republic of Korea
| | - Yoo-Min Kim
- Department of Surgery, Dong-A University College of Medicine, Busan 602-715, Republic of Korea
| | - Ghap-Joong Jung
- Dong-A University College of Medicine, Busan 602-715, Republic of Korea; Department of Surgery, Dong-A University College of Medicine, Busan 602-715, Republic of Korea
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22
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Barbas AS, Turley RS, Mallipeddi MK, Lidsky ME, Reddy SK, White RR, Clary BM. Examining reoperation and readmission after hepatic surgery. J Am Coll Surg 2013; 216:915-23. [PMID: 23518253 DOI: 10.1016/j.jamcollsurg.2013.01.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/01/2013] [Accepted: 01/03/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although the perioperative mortality from hepatic resection has improved considerably, this procedure is still associated with substantial morbidity and resource use. The goal of this investigation was to characterize the incidence, patterns, and risk factors for early reoperation and readmission after hepatectomy. STUDY DESIGN Perioperative outcomes of 1,281 patients undergoing hepatic resection at an academic center from 1996 to 2009 were analyzed. The indications for early reoperation and readmission (90 days) were reviewed. Multivariate logistic regression analysis was performed to determine variables associated with reoperation and readmission. A scoring system was generated to predict the need for readmission after hepatectomy. RESULTS Eighty-seven patients (6.8%) required reoperation. The perioperative mortality in patients requiring reoperation was significantly higher than for those not requiring reoperation (23.0% vs 3.4%; p < 0.001). Variables associated with reoperation included male sex, performance of concomitant major nonhepatic procedures, and greater intraoperative blood loss. One hundred and eighty-four patients (14.4%) required readmission. Variables associated with readmission included major hepatectomy, development of major postoperative complications, and index hospitalization >7 days. A Readmission Prediction Score ranging from 0 to 4 was generated and directly correlated with need for readmission. CONCLUSIONS In the current era of hepatic surgery, early reoperation and readmission remain relatively frequent. As we care for patients who are increasingly receiving regionalized care far from home, we must be mindful of patients at increased risk for readmission. The development of strategies to minimize the complications that necessitate reoperation and readmission is critical to improving patient care.
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Affiliation(s)
- Andrew S Barbas
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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