FAILURE TO RESCUE AFTER GASTRECTOMY: A NEW INDICATOR OF SURGICAL QUALITY

Stefany HONG, Marina Alessandra PEREIRA, André Roncon DIAS, Ulysses RIBEIRO JUNIOR, Luiz Augusto Carneiro D’ALBUQUERQUE, Marcus Fernando Kodama Pertille RAMOS
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Abstract

ABSTRACT BACKGROUND: The main treatment modality for gastric cancer is surgical resection with lymphadenectomy. Despite advances in perioperative care, major surgical complications can occur in up to 20% of cases. To determine the quality of surgical care employed, a new indicator called failure to rescue (FTR) was proposed, which assesses the percentage of patients who die after complications occur. AIMS: To assess the rate of FTR after gastrectomy and factors associated with its occurrence. METHODS: Patients with gastric cancer who underwent gastrectomy with curative intent were retrospectively evaluated. According to the occurrence of postoperative complications, patients were divided into FTR group (grade V complications) and rescued group (grade III/IV complications). RESULTS: Among the 731 patients, 114 had major complications. Of these patients, 76 (66.7%) were successfully treated for the complication (rescued group), while 38 (33.3%) died (FTR group). Patients in the FTR group were older (p=0.008; p<0.05), had lower levels of hemoglobin (p=0.021; p<0.05) and albumin (p=0.002; p<0.05), and a higher frequency of ASA III/IV (p=0.033; p<0.05). There were no differences between the groups regarding surgical and pathological characteristics. Clinical complications had a higher mortality rate (40.0% vs 30.4%), with pulmonary complications (50.2%) and infections (46.2%) being the most lethal. Patients with major complications grade III/IV had worse survival than those without complications. CONCLUSIONS: The FTR rate was 33.3%. Advanced age, worse performance, and nutritional parameters were associated with FTR.
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胃切除术后抢救失败:评价手术质量的新指标
背景:胃癌的主要治疗方式是手术切除加淋巴结切除术。尽管围手术期护理取得了进展,但高达20%的病例可能发生重大手术并发症。为了确定所采用的手术护理的质量,提出了一个新的指标,称为抢救失败(FTR),它评估并发症发生后患者死亡的百分比。目的:探讨胃切除术后FTR的发生率及其发生的相关因素。方法:回顾性分析以治愈为目的行胃切除术的胃癌患者。根据术后并发症的发生情况将患者分为FTR组(V级并发症)和获救组(III/IV级并发症)。结果:731例患者中有114例出现严重并发症。其中抢救组76例(66.7%)并发症治疗成功,FTR组38例(33.3%)死亡。FTR组患者年龄较大(p=0.008;p < 0.05),血红蛋白水平较低(p=0.021;p= 0.05)和白蛋白(p=0.002;p < 0.05), ASA III/IV的发生率较高(p=0.033;术中,0.05)。两组间手术及病理特征无差异。临床并发症的死亡率更高(40.0% vs 30.4%),其中肺部并发症(50.2%)和感染(46.2%)是最致命的。有主要并发症的III/IV级患者的生存期比无并发症的患者差。结论:FTR率为33.3%。高龄、较差的表现和营养参数与FTR有关。
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来源期刊
CiteScore
2.20
自引率
53.30%
发文量
55
审稿时长
16 weeks
期刊最新文献
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