Abstract
Aims
Previous research suggests that patients undergoing upper gastrointestinal surgery
are at high risk of poor postoperative outcomes. The aim of our study was to describe
patient outcomes after elective upper gastrointestinal surgery at a global level.
Methods
Prospective analysis of data collected during an international seven-day cohort study
of 474 hospitals in 27 countries. Patients undergoing elective upper gastrointestinal
surgery were recruited. Outcome measures were in-hospital complications and mortality
at 30-days. Results are presented as n(%) and odds ratios with 95% confidence intervals.
Results
2139 patients were included, of whom 498 (23.2%) developed one or more postoperative
complications, with 30 deaths (1.4%). Patients with complications had longer median
hospital stay 11 (6–18) days vs. 5 (2–10) days. Infectious complications were most
frequent, affecting 368 (17.2%) patients. 328 (15.3%) patients were admitted to critical
care postoperatively, of whom 161 (49.1%) developed a complication with 14 deaths
(4.3%). In a multivariable logistic regression model we identified age (OR 1.02 [1.01–1.03]),
American Society of Anesthesiologists physical status III (OR 2.12 [1.44–3.16]) and
IV (OR 3.23 [1.72–6.09]), surgery for cancer (OR 1.63 [1.27–2.11]), open procedure
(OR 1.40 [1.10–1.78]), intermediate surgery (OR 1.75 [1.12–2.81]) and major surgery
(OR 2.65 [1.72–4.23]) as independent risk factors for postoperative complications.
Patients undergoing major surgery for upper gastrointestinal cancer experienced twice
the rate of complications compared to those undergoing other procedures (224/578 patients
[38.8%] versus 274/1561 patients [17.6%]).
Conclusions
Complications and death are common after upper gastrointestinal surgery. Patients
undergoing major surgery for cancer are at greatest risk.
Keywords
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Article info
Publication history
Published online: August 17, 2017
Accepted:
August 4,
2017
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
