Benchmarking Complications Associated with Esophagectomy

Donald E. Low, Madhan Kumar Kuppusamy, Derek Alderson, Ivan Cecconello, Andrew C. Chang, Gail Darling, Andrew Davies, Xavier Benoit D'Journo, Suzanne S. Gisbertz, S. Michael Griffin, Richard Hardwick, Arnulf Hoelscher, Wayne Hofstetter, Blair Jobe, Yuukou Kitagawa, Simon Law, Christophe Mariette, Nick Maynard, Christopher R. Morse, Philippe Nafteux & 7 others Manuel Pera, C. S. Pramesh, Sonia Puig, John V. Reynolds, Wolfgang Schroeder, Mark Smithers, B. P.L. Wijnhoven

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

OBJECTIVE: Utilizing a standardized dataset with specific definitions to prospectively collect international data to provide a benchmark for complications and outcomes associated with esophagectomy. SUMMARY OF BACKGROUND DATA: Outcome reporting in oncologic surgery has suffered from the lack of a standardized system for reporting operative results particularly complications. This is particularly the case for esophagectomy affecting the accuracy and relevance of international outcome assessments, clinical trial results, and quality improvement projects. METHODS: The Esophageal Complications Consensus Group (ECCG) involving 24 high-volume esophageal surgical centers in 14 countries developed a standardized platform for recording complications and quality measures associated with esophagectomy. Using a secure online database (ESODATA.org), ECCG centers prospectively recorded data on all resections according to the ECCG platform from these centers over a 2-year period. RESULTS: Between January 2015 and December 2016, 2704 resections were entered into the database. All demographic and follow-up data fields were 100% complete. The majority of operations were for cancer (95.6%) and typically located in the distal esophagus (56.2%). Some 1192 patients received neoadjuvant chemoradiation (46.1%) and 763 neoadjuvant chemotherapy (29.5%). Surgical approach involved open procedures in 52.1% and minimally invasive operations in 47.9%. Chest anastomoses were done most commonly (60.7%) and R0 resections were accomplished in 93.4% of patients. The overall incidence of complications was 59% with the most common individual complications being pneumonia (14.6%) and atrial dysrhythmia (14.5%). Anastomotic leak, conduit necrosis, chyle leaks, recurrent nerve injury occurred in 11.4%, 1.3%, 4.7%, and 4.2% of cases, respectively. Clavien-Dindo complications ≥ IIIb occurred in 17.2% of patients. Readmissions occurred in 11.2% of cases and 30- and 90-day mortality was 2.4% and 4.5%, respectively. CONCLUSION: Standardized methods provide contemporary international benchmarks for reporting outcomes after esophagectomy.

Original languageEnglish
Pages (from-to)291-298
Number of pages8
JournalAnnals of surgery
Volume269
Issue number2
DOIs
Publication statusPublished - 2019 Feb 1

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Benchmarking
Esophagectomy
Chyle
Databases
Anastomotic Leak
Quality Improvement
Developed Countries
Esophagus
Pneumonia
Necrosis
Thorax
Demography
Outcome Assessment (Health Care)
Clinical Trials
Drug Therapy
Mortality
Incidence
Wounds and Injuries
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Low, D. E., Kuppusamy, M. K., Alderson, D., Cecconello, I., Chang, A. C., Darling, G., ... Wijnhoven, B. P. L. (2019). Benchmarking Complications Associated with Esophagectomy. Annals of surgery, 269(2), 291-298. https://doi.org/10.1097/SLA.0000000000002611

Benchmarking Complications Associated with Esophagectomy. / Low, Donald E.; Kuppusamy, Madhan Kumar; Alderson, Derek; Cecconello, Ivan; Chang, Andrew C.; Darling, Gail; Davies, Andrew; D'Journo, Xavier Benoit; Gisbertz, Suzanne S.; Griffin, S. Michael; Hardwick, Richard; Hoelscher, Arnulf; Hofstetter, Wayne; Jobe, Blair; Kitagawa, Yuukou; Law, Simon; Mariette, Christophe; Maynard, Nick; Morse, Christopher R.; Nafteux, Philippe; Pera, Manuel; Pramesh, C. S.; Puig, Sonia; Reynolds, John V.; Schroeder, Wolfgang; Smithers, Mark; Wijnhoven, B. P.L.

In: Annals of surgery, Vol. 269, No. 2, 01.02.2019, p. 291-298.

Research output: Contribution to journalArticle

Low, DE, Kuppusamy, MK, Alderson, D, Cecconello, I, Chang, AC, Darling, G, Davies, A, D'Journo, XB, Gisbertz, SS, Griffin, SM, Hardwick, R, Hoelscher, A, Hofstetter, W, Jobe, B, Kitagawa, Y, Law, S, Mariette, C, Maynard, N, Morse, CR, Nafteux, P, Pera, M, Pramesh, CS, Puig, S, Reynolds, JV, Schroeder, W, Smithers, M & Wijnhoven, BPL 2019, 'Benchmarking Complications Associated with Esophagectomy', Annals of surgery, vol. 269, no. 2, pp. 291-298. https://doi.org/10.1097/SLA.0000000000002611
Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC, Darling G et al. Benchmarking Complications Associated with Esophagectomy. Annals of surgery. 2019 Feb 1;269(2):291-298. https://doi.org/10.1097/SLA.0000000000002611
Low, Donald E. ; Kuppusamy, Madhan Kumar ; Alderson, Derek ; Cecconello, Ivan ; Chang, Andrew C. ; Darling, Gail ; Davies, Andrew ; D'Journo, Xavier Benoit ; Gisbertz, Suzanne S. ; Griffin, S. Michael ; Hardwick, Richard ; Hoelscher, Arnulf ; Hofstetter, Wayne ; Jobe, Blair ; Kitagawa, Yuukou ; Law, Simon ; Mariette, Christophe ; Maynard, Nick ; Morse, Christopher R. ; Nafteux, Philippe ; Pera, Manuel ; Pramesh, C. S. ; Puig, Sonia ; Reynolds, John V. ; Schroeder, Wolfgang ; Smithers, Mark ; Wijnhoven, B. P.L. / Benchmarking Complications Associated with Esophagectomy. In: Annals of surgery. 2019 ; Vol. 269, No. 2. pp. 291-298.
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abstract = "OBJECTIVE: Utilizing a standardized dataset with specific definitions to prospectively collect international data to provide a benchmark for complications and outcomes associated with esophagectomy. SUMMARY OF BACKGROUND DATA: Outcome reporting in oncologic surgery has suffered from the lack of a standardized system for reporting operative results particularly complications. This is particularly the case for esophagectomy affecting the accuracy and relevance of international outcome assessments, clinical trial results, and quality improvement projects. METHODS: The Esophageal Complications Consensus Group (ECCG) involving 24 high-volume esophageal surgical centers in 14 countries developed a standardized platform for recording complications and quality measures associated with esophagectomy. Using a secure online database (ESODATA.org), ECCG centers prospectively recorded data on all resections according to the ECCG platform from these centers over a 2-year period. RESULTS: Between January 2015 and December 2016, 2704 resections were entered into the database. All demographic and follow-up data fields were 100{\%} complete. The majority of operations were for cancer (95.6{\%}) and typically located in the distal esophagus (56.2{\%}). Some 1192 patients received neoadjuvant chemoradiation (46.1{\%}) and 763 neoadjuvant chemotherapy (29.5{\%}). Surgical approach involved open procedures in 52.1{\%} and minimally invasive operations in 47.9{\%}. Chest anastomoses were done most commonly (60.7{\%}) and R0 resections were accomplished in 93.4{\%} of patients. The overall incidence of complications was 59{\%} with the most common individual complications being pneumonia (14.6{\%}) and atrial dysrhythmia (14.5{\%}). Anastomotic leak, conduit necrosis, chyle leaks, recurrent nerve injury occurred in 11.4{\%}, 1.3{\%}, 4.7{\%}, and 4.2{\%} of cases, respectively. Clavien-Dindo complications ≥ IIIb occurred in 17.2{\%} of patients. Readmissions occurred in 11.2{\%} of cases and 30- and 90-day mortality was 2.4{\%} and 4.5{\%}, respectively. CONCLUSION: Standardized methods provide contemporary international benchmarks for reporting outcomes after esophagectomy.",
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AU - Low, Donald E.

AU - Kuppusamy, Madhan Kumar

AU - Alderson, Derek

AU - Cecconello, Ivan

AU - Chang, Andrew C.

AU - Darling, Gail

AU - Davies, Andrew

AU - D'Journo, Xavier Benoit

AU - Gisbertz, Suzanne S.

AU - Griffin, S. Michael

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AU - Hoelscher, Arnulf

AU - Hofstetter, Wayne

AU - Jobe, Blair

AU - Kitagawa, Yuukou

AU - Law, Simon

AU - Mariette, Christophe

AU - Maynard, Nick

AU - Morse, Christopher R.

AU - Nafteux, Philippe

AU - Pera, Manuel

AU - Pramesh, C. S.

AU - Puig, Sonia

AU - Reynolds, John V.

AU - Schroeder, Wolfgang

AU - Smithers, Mark

AU - Wijnhoven, B. P.L.

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N2 - OBJECTIVE: Utilizing a standardized dataset with specific definitions to prospectively collect international data to provide a benchmark for complications and outcomes associated with esophagectomy. SUMMARY OF BACKGROUND DATA: Outcome reporting in oncologic surgery has suffered from the lack of a standardized system for reporting operative results particularly complications. This is particularly the case for esophagectomy affecting the accuracy and relevance of international outcome assessments, clinical trial results, and quality improvement projects. METHODS: The Esophageal Complications Consensus Group (ECCG) involving 24 high-volume esophageal surgical centers in 14 countries developed a standardized platform for recording complications and quality measures associated with esophagectomy. Using a secure online database (ESODATA.org), ECCG centers prospectively recorded data on all resections according to the ECCG platform from these centers over a 2-year period. RESULTS: Between January 2015 and December 2016, 2704 resections were entered into the database. All demographic and follow-up data fields were 100% complete. The majority of operations were for cancer (95.6%) and typically located in the distal esophagus (56.2%). Some 1192 patients received neoadjuvant chemoradiation (46.1%) and 763 neoadjuvant chemotherapy (29.5%). Surgical approach involved open procedures in 52.1% and minimally invasive operations in 47.9%. Chest anastomoses were done most commonly (60.7%) and R0 resections were accomplished in 93.4% of patients. The overall incidence of complications was 59% with the most common individual complications being pneumonia (14.6%) and atrial dysrhythmia (14.5%). Anastomotic leak, conduit necrosis, chyle leaks, recurrent nerve injury occurred in 11.4%, 1.3%, 4.7%, and 4.2% of cases, respectively. Clavien-Dindo complications ≥ IIIb occurred in 17.2% of patients. Readmissions occurred in 11.2% of cases and 30- and 90-day mortality was 2.4% and 4.5%, respectively. CONCLUSION: Standardized methods provide contemporary international benchmarks for reporting outcomes after esophagectomy.

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