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Understanding mortality as a quality indicator after esophagectomy.
Dustin M Walters1, Timothy L McMurry2, James M Isbell1
1Department of Surgery, The University of Virginia, Charlottesville, Virginia.
The Annals of Thoracic Surgery
|May 21, 2014
Summary
Ninety-day mortality after esophagectomy is more than double the 30-day rate, revealing a higher true risk for cancer patients. This 90-day measure offers a better understanding of postoperative death risk than the 30-day indicator.
Area of Science:
- Oncology
- Surgical Outcomes
- Health Services Research
Background:
- Postoperative mortality is a critical outcome following esophagectomy.
- Current quality metrics, like 30-day mortality, may underestimate true patient risk.
- Esophageal cancer surgery necessitates accurate assessment of patient survival.
Purpose of the Study:
- To evaluate and compare different definitions of postoperative mortality after esophagectomy for cancer.
- To determine the most accurate measure of death risk for patients undergoing this procedure.
- To assess the utility of various mortality definitions as hospital quality indicators.
Main Methods:
- Utilized the Surveillance, Epidemiology and End Results-Medicare registry (2006-2009).
- Compared 30-day, in-hospital, perioperative, and 90-day mortality rates.
- Employed hierarchical logistic regression to analyze risk factors and hospital performance.
Main Results:
- Identified 634 patients from 188 hospitals.
- Ninety-day mortality (13.3%) was over double the 30-day rate (6.0%).
- Advanced age and COPD increased 90-day mortality risk; neither 30-day nor 90-day rates distinguished hospital performance.
Conclusions:
- Clinically significant differences exist between postoperative mortality definitions.
- Thirty-day mortality underestimates true death risk in elderly Medicare patients undergoing esophagectomy.
- Ninety-day mortality provides a more comprehensive understanding of patient death risk, though neither metric adequately measures hospital quality.