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Title: Textbook outcomes after oesophagectomy: a single-centre observational study.
Austin Authors: Buchholz, Vered;Hazard, Riley;Lee, Dong-Kyu;Liu, David Shi Hao ;Zhang, Wendell;Chen, Sharon;Aly, Ahmed;Barnett, Stephen A ;Le, Peter;Weinberg, Laurence 
Affiliation: Surgery (University of Melbourne)
Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Melbourne, Australia.;General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Austin, USA.;Division of Cancer Surgery, The Peter MacCallum Cancer Centre, Melbourne, Precinct, VIC, Australia.
Division of Cancer Surgery, The Peter MacCallum Cancer Centre, Melbourne, Precinct, VIC, Australia.
Department of Critical Care, University of Melbourne, Victoria, Australia.
Issue Date: 8-Dec-2023
Date: 2023
Publication information: BMC Surgery 2023-12-08; 23(1)
Abstract: Textbook outcomes is a composite quality assurance tool assessing the ideal perioperative and postoperative course as a unified measure. Currently, its definition and application in the context of oesophagectomy in Australia is unknown. The aim of this study was to assess the textbook outcomes after oesophagectomy in a single referral centre of Australia and investigate the association between textbook outcomes and patient, tumour, and treatment characteristics. An observational study was retrospectively performed on patients undergoing open, laparoscopic, or hybrid oesophagectomy between January 2010 and December 2019 in a single cancer referral centre. A textbook outcome was defined as the fulfillment of 10 criteria: R0 resection, retrieval of at least 15 lymph nodes, no intraoperative complications, no postoperative complications greater than Clavien-Dindo grade III, no anastomotic leak, no readmission to the ICU, no hospital stay beyond 21 days, no mortality within 90 days, no readmission related to the surgical procedure within 30 days from admission and no reintervention related to the surgical procedure. The proportion of patients who met each criterion for textbook outcome was calculated and compared. Selected patient-related parameters (age, gender, BMI, ASA score, CCI score), tumour-related factors (tumour location, tumour histology, AJCC clinical T and N stage and treatment-related factor [neoadjuvant chemotherapy and surgical approach]) were assessed. Disease recurrence and one year survival were also evaluated. 110 patients who underwent oesophagectomy were included. The overall textbook outcome rate was 24%. The difference in rates across the years was not statistically significant. The most achieved textbook outcome parameters were 'no mortality in 90 days' (96%) and 'R0 resection' (89%). The least frequently met textbook outcome parameter was 'no severe postoperative complications' (58%), followed by 'no hospital stays over 21 days' (61%). No significant association was found between patient, tumour and treatment characteristics and the rate of textbook outcome. Tumour recurrence rate and overall long term survival was similar between textbook outcome and non-textbook outcome groups. Patients with R0 resection, no intraoperative complication and a hospital stay less than 21 days had reduced mortality rates. Textbook outcome is a clinically relevant indicator and was achieved in 24% of patients. Severe complications and a prolonged hospital stay were the key criteria that limited the achievement of a textbook outcome. These findings provide meticulous evaluation of oesophagectomy perioperative care and provide a direction for the utilisation of this concept in identifying and improving surgical and oncological care across multiple healthcare levels.
DOI: 10.1186/s12893-023-02253-7
Journal: BMC Surgery
Start page: 368
PubMed URL: 38066440
ISSN: 1471-2482
Type: Journal Article
Subjects: Anaesthesia
Textbook outcome
Esophagectomy/adverse effects
Neoplasm Recurrence, Local/surgery
Postoperative Complications/etiology
Anastomotic Leak/etiology
Intraoperative Complications/etiology
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