Outcome-volume relationships and transhiatal esophagectomy: minimizing “failure to rescue”

Annals of Surgical Innovation and Research

Renee L Arlow³  Dirk F Moore¹  Chunxia Chen¹  John Langenfeld²  David A August³ 

[1] Department of Biostatistics, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick 08903-2601, New Jersey, USA

[2] Department of Surgery, Section of Thoracic Surgery, Rutgers Robert Wood Johnson Medical School and The Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick 08903-2601, New Jersey, USA

[3] Department of Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick 08903-2601, New Jersey, USA

关键词: Postoperative complication;    Quality improvement;    Outcome-volume relationships;    Failure to rescue;    Esophageal cancer;    Esophagectomy;   

Others  :  1083880
DOI  :  10.1186/s13022-014-0009-3

 received in 2014-09-21, accepted in 2014-12-02,  发布年份 2014

【 摘 要 】

Background

The objective of this study is to describe the system and technical factors that enabled our moderate size transhiatal esophagectomy program to achieve low mortality rates.

Methods

A retrospective chart review was conducted on 200 consecutive patients who underwent transhiatal esophagectomy at Robert Wood Johnson University Hospital. Primary outcomes included operative times, estimated blood loss, frequency and nature of complications, and lengths of stay in the hospital and the intensive care unit.

Results

In general, surgical outcomes tended to improve over the course of this study. We identified decreased operative time, intra-operative blood loss, frequency of complications, and lengths of intensive care unit and hospital stay as the program matured. Through coordinated actions of the surgical and anesthesia teams, all intraoperative injuries were responded to in an effective, emergent fashion and all but one patient was saved. This resulted in an inhospital and 30-day mortality rate of only 0.5%.

Conclusions

Our study suggests that a dual attending approach, focus on avoiding “failure to rescue”, increased volume, and a surgeon driven commitment to quality improvement may lead to low mortality rates after transhiatal esophagectomy.

【 授权许可】

   
2014 Arlow et al.; licensee BioMed Central.

【 图 表 】

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Figure 2.

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