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Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation. Results from the Dutch Upper Gastrointestinal Cancer Audit |
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| Institution: | 4. Department of Surgery, Ziekenhuisgroep Groep Twente, Almelo, the Netherlands;5. Department of Surgery, Gelre Hospital, Apeldoorn, the Netherlands;6. Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands;7. Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands;8. Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands;9. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands;10. Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands;11. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands;12. Department of Surgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, the Netherlands;13. Department of Surgery, Leeuwarden Medical Center, Leeuwarden, the Netherlands;14. Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands;15. Department of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands;p. Department of Surgery, Zuyderland Medical Center, Sittard-Geleen and Heerlen, the Netherlands;q. Department of Surgery, Erasmus MC, Rotterdam, the Netherlands;1. Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands;2. Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands;3. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands |
| Abstract: | IntroductionThe value of routine intensive care unit (ICU) admission after minimally invasive esophagectomy (MIE) has been questioned. This study aimed to investigate Dutch hospital variation regarding length of direct postoperative ICU stay, and the impact of this hospital variation on short-term surgical outcomes.Materials and methodsPatients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) undergoing curative MIE were included. Length of direct postoperative ICU stay was dichotomized around the national median into short ICU stay ( ≤ 1 day) and long ICU stay ( > 1 day). A case-mix corrected funnel plot based on multivariable logistic regression analyses investigated hospital variation. The impact of this hospital variation on short-term surgical outcomes was investigated using multilevel multivariable logistic regression analyses.ResultsBetween 2017 and 2019, 2110 patients from 16 hospitals were included. Median length of postoperative ICU stay was 1 day hospital variation: 0–4]. The percentage of short ICU stay ranged from 0 to 91% among hospitals. Corrected for case-mix, 7 hospitals had statistically significantly higher short ICU stay rates and 6 hospitals had lower rates. ICU readmission, in-hospital/30-day mortality, failure to rescue, postoperative pneumonia, cardiac complications and anastomotic leakage were not associated with hospital variation in length of ICU stay. Total length of hospital stay was significantly shorter in hospitals with relatively short ICU stay.ConclusionThis study showed significant hospital variation in postoperative length of ICU stay after MIE. Short ICU stay was associated with shorter overall hospital admission and did not negatively impact short-term surgical outcomes. More selected use of ICU resources could result in a national significant cost reduction. |
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