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Critical Care
Published in: Critical Care 2/2009

Open Access 01-04-2009 | Research

Outcomes following oesophagectomy in patients with oesophageal cancer: a secondary analysis of the ICNARC Case Mix Programme Database

Authors: Daniel P Park, Catherine A Welch, David A Harrison, Thomas R Palser, David A Cromwell, Fang Gao, Derek Alderson, Katherine M Rowan, Gavin D Perkins

Published in: Critical Care | Special Issue 2/2009

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Abstract

Introduction

This report describes the case mix and outcomes of patients with oesophageal cancer admitted to adult critical care units following elective oesophageal surgery in England, Wales and Northern Ireland.

Methods

Admissions to critical care following elective oesophageal surgery for malignancy were identified using data from the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme Database. Information on admissions between December 1995 and September 2007 were extracted and the association between in-hospital mortality and patient characteristics on admission to critical care was assessed using multiple logistic regression analysis. The performance of three prognostic models (Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II and the ICNARC physiology score) was also evaluated.

Results

Between 1995 and 2007, there were 7227 admissions to 181 critical care units following oesophageal surgery for malignancy. Overall mortality in critical care was 4.4% and in-hospital mortality was 11%, although both declined steadily over time. Eight hundred and seventy-three (12.2%) patients were readmitted to critical care, most commonly for respiratory complications (49%) and surgical complications (25%). Readmitted patients had a critical care unit mortality of 24.7% and in-hospital mortality of 33.9%. Overall in-hospital mortality was associated with patient age, and various physiological measurements on admission to critical care (partial pressure of arterial oxygen (PaO2):fraction of inspired oxygen (FiO2) ratio, lowest arterial pH, mechanical ventilation, serum albumin, urea and creatinine). The three prognostic models evaluated performed poorly in measures of discrimination, calibration and goodness of fit.

Conclusions

Surgery for oesophageal malignancy continues to be associated with significant morbidity and mortality. Age and organ dysfunction in the early postoperative period are associated with an increased risk of death. Postoperative serum albumin is confirmed as an additional prognostic factor. More work is required to determine how this knowledge may improve clinical management.
Literature
1.
Parkin D, Bray F, Ferlay J, Pisani P: Global cancer statistics, 2002. CA Cancer J Clin 2005, 55: 74-108. 10.3322/canjclin.55.2.74CrossRefPubMed
2.
National Oesophago-Gastric Cancer Audit: First Annual Report The NHS Information Centre; 2008.
3.
4.
Jamieson G, Mathew G, Ludemann R, Wayman J, Myers J, Devitt P: Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 2004, 91: 943-947. 10.1002/bjs.4596CrossRefPubMed
5.
Lund O, Kimose H, Aagaard M, Hasenkam J, Erlandsen M: Risk stratification and long-term results after surgical treatment of carcinomas of the thoracic esophagus and cardia. A 25-year retrospective study. J Thorac Cardiovasc Surg 1990, 99: 200-209.PubMed
6.
Ferguson M, Martin T, Reeder L, Olak J: Mortality after esophagectomy: risk factor analysis. World J Surg 1997, 21: 599-604. 10.1007/s002689900279CrossRefPubMed
7.
Bartels H, Stein H, Siewert J: Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg 1998, 85: 840-844. 10.1046/j.1365-2168.1998.00663.xCrossRefPubMed
8.
Karl R, Schreiber R, Boulware D, Baker S, Coppola D: Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg 2000, 231: 635-643. 10.1097/00000658-200005000-00003PubMedCentralCrossRefPubMed
9.
Bailey S, Bull D, Harpole D, Rentz J, Neumayer L, Pappas T, Daley J, Henderson W, Krasnicka B, Khuri S: Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg 2003, 75: 217-222. discussion 222. 10.1016/S0003-4975(02)04368-0CrossRefPubMed
10.
Sanz L, Ovejero V, González J, Laso C, Azcano E, Navarrete F, Martínez E: Mortality risk scales in esophagectomy for cancer: their usefulness in preoperative patient selection. Hepatogastroenterology 2006, 53: 869-873.PubMed
11.
Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Dataset Specification, Version 2.0 London: ICNARC; 1997.
12.
Harrison D, Brady A, Rowan K: Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database. Crit Care 2004, 8: R99-111. 10.1186/cc2834PubMedCentralCrossRefPubMed
13.
14.
Young J, Goldfrad C, Rowan K: Development and testing of a hierarchical method to code the reason for admission to intensive care units: the ICNARC Coding Method. Intensive Care National Audit & Research Centre. Br J Anaesth 2001, 87: 543-548. 10.1093/bja/87.4.543CrossRefPubMed
15.
Knaus W, Draper E, Wagner D, Zimmerman J: APACHE II: a severity of disease classification system. Crit Care Med 1985, 13: 818-829. 10.1097/00003246-198510000-00009CrossRefPubMed
16.
Harrison D, Parry G, Carpenter J, Short A, Rowan K: A new risk prediction model for critical care: the Intensive Care National Audit & Research Centre (ICNARC) model. Crit Care Med 2007, 35: 1091-1098. 10.1097/01.CCM.0000259468.24532.44CrossRefPubMed
17.
Le Gall J, Lemeshow S, Saulnier F: A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. J Am Med Assoc 1993, 270: 2957-2963. 10.1001/jama.270.24.2957CrossRef
18.
Rowan K: Outcome comparisons of intensive care units in Great Britain and Ireland using the APACHE II method. In DPhil thesis. Oxford University, Department of Public Health and Primary Care; 1992.
19.
Bamber D: The area above the ordinal dominance graph and the area below the receiver operating characteristic graph. J Math Psychol 1975, 12: 387-415. 10.1016/0022-2496(75)90001-2CrossRef
20.
Hosmer DW, Lemeshow S: Goodness of fit tests for the multiple logistic regression model. Communications in Statistics – Theory and Methods 1980, 9: 1043-1069. 10.1080/03610928008827941CrossRef
21.
Cox DR: Two further applications of a model for binary regression. Biometrika 1958, 45: 562-565.CrossRef
22.
Brier GW: Verification of forecasts expressed in terms of probability. Monthly Weather Review 1950, 78: 1-3. 10.1175/1520-0493(1950)078<0001:VOFEIT>2.0.CO;2CrossRef
23.
McCulloch P, Ward J, Tekkis P: Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ 2003, 327: 1192-1197. 10.1136/bmj.327.7425.1192PubMedCentralCrossRefPubMed
24.
Earlam R, Cunha-Melo J: Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg 1980, 67: 381-390. 10.1002/bjs.1800670602CrossRefPubMed
25.
Müller J, Erasmi H, Stelzner M, Zieren U, Pichlmaier H: Surgical therapy of oesophageal carcinoma. Br J Surg 1990, 77: 845-857. 10.1002/bjs.1800770804CrossRefPubMed
26.
Metzger R, Bollschweiler E, Vallböhmer D, Maish M, DeMeester T, Hölscher A: High volume centers for esophagectomy: what is the number needed to achieve low postoperative mortality? Dis Esophagus 2004, 17: 310-314. 10.1111/j.1442-2050.2004.00431.xCrossRefPubMed
27.
Guidance on commisioning cancer services. Improving outcomes in upper gastrointestinal cancer London: Department of Health; 2001.
28.
Ferguson M, Durkin A: Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg 2002, 123: 661-669. 10.1067/mtc.2002.120350CrossRefPubMed
29.
Hulscher J, Tijssen J, Obertop H, van Lanschot J: Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 2001, 72: 306-313. 10.1016/S0003-4975(00)02570-4CrossRefPubMed
30.
31.
Rocker G, Wiseman M, Pearson D, Shale D: Neutrophil degranulation and increased pulmonary capillary permeability following oesophagectomy: a model of early lung injury in man. Br J Surg 1988, 75: 883-886. 10.1002/bjs.1800750918CrossRefPubMed
32.
Schilling M, Eichenberger M, Maurer C, Sigurdsson G, Büchler M: Ketoconazole and pulmonary failure after esophagectomy: a prospective clinical trial. Dis Esophagus 2001, 14: 37-40. 10.1111/j.1442-2050.2001.00158.xCrossRefPubMed
33.
Gockel I, Exner C, Junginger T: Morbidity and mortality after esophagectomy for esophageal carcinoma: a risk analysis. World J Surg Oncol 2005, 3: 37. 10.1186/1477-7819-3-37PubMedCentralCrossRefPubMed
34.
Tandon S, Batchelor A, Bullock R, Gascoigne A, Griffin M, Hayes N, Hing J, Shaw I, Warnell I, Baudouin S: Peri-operative risk factors for acute lung injury after elective oesophagectomy. Br J Anaesth 2001, 86: 633-638. 10.1093/bja/86.5.633CrossRefPubMed
35.
Ryan A, Hearty A, Prichard R, Cunningham A, Rowley S, Reynolds J: Association of hypoalbuminemia on the first postoperative day and complications following esophagectomy. J Gastrointest Surg 2007, 11: 1355-1360. 10.1007/s11605-007-0223-yCrossRefPubMed
36.
Kuwano H, Sumiyoshi K, Sonoda K, Kitamura K, Tsutsui S, Toh Y, Kitamura M, Sugimachi K: Relationship between preoperative assessment of organ function and postoperative morbidity in patients with oesophageal cancer. Eur J Surg 1998, 164: 581-586. 10.1080/110241598750005679CrossRefPubMed
37.
Avendano C, Flume P, Silvestri G, King L, Reed C: Pulmonary complications after esophagectomy. Ann Thorac Surg 2002, 73: 922-926. 10.1016/S0003-4975(01)03584-6CrossRefPubMed
38.
Azim K, McManus R, Brophy K, Ryan A, Kelleher D, Reynolds J: Genetic polymorphisms and the risk of infection following esophagectomy. Positive association with TNF-alpha gene -308 genotype. Ann Surg 2007, 246: 122-128. 10.1097/01.sla.0000259389.09161.49PubMedCentralCrossRefPubMed
Metadata
Title
Outcomes following oesophagectomy in patients with oesophageal cancer: a secondary analysis of the ICNARC Case Mix Programme Database
Authors
Daniel P Park
Catherine A Welch
David A Harrison
Thomas R Palser
David A Cromwell
Fang Gao
Derek Alderson
Katherine M Rowan
Gavin D Perkins
Publication date
01-04-2009
Publisher
BioMed Central
Published in
Critical Care / Issue Special Issue 2/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc7868