TY - JOUR
T1 - 30-Day Outcomes Following Esophageal Replacement in Children
T2 - A National Surgical Quality Improvement Project Pediatric Analysis
AU - Bludevich, Bryce M.
AU - Kauffman, Jeremy D.
AU - Smithers, Charles J.
AU - Danielson, Paul D.
AU - Chandler, Nicole M.
N1 - Funding Information:
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Disclaimer: The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used in this study; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. Author contributions: All authors made substantial contributions to the conception or design of the work (J.D.K. P.D.D. N.M.C.); or the acquisition, analysis, or interpretation of data for the work (J.D.K. B.M.B. P.D.D. N.M.C.); drafting the work or revising it critically for important intellectual content (J.D.K. B.M.B. C.J.S. P.D.D. N.M.C.); and final approval of the version to be published (J.D.K. B.M.B. C.J.S. P.D.D. N.M.C.). All authors (J.D.K. B.M.B. C.J.S. P.D.D. N.M.C.) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Publisher Copyright:
© 2020
PY - 2020/11
Y1 - 2020/11
N2 - Introduction: The optimal method of esophageal replacement remains controversial. The aim of this study was to evaluate 30-d outcomes of children in the National Surgical Quality Improvement Project Pediatric (NSQIP-P) database who underwent esophageal replacement from 2012 to 2018. Methods: Demographics, comorbidities, and procedural technique was identified in NSQIP-P and reviewed. Thirty-day outcomes were assessed and stratified by gastric pull-up or tube interposition versus small bowel or colonic interposition. Categorical and continuous variables were assessed by Pearson's chi-square, Fisher's exact, and Wilcoxon rank-sum tests, respectively. Multivariate logistic regression was performed to estimate the effects of procedure technique and clinical risk factors on patient outcomes. Results: Of the 99 cases of esophageal replacement included, 52 (52.5%) utilized a gastric conduit, whereas 47 (47.5%) involved small bowel/colonic esophageal interposition. Overall risk of complications was 52.5%, the most common of which were perioperative transfusion (30.3%), surgical site infection (11.1%), and sepsis (9.1%). Risk of unplanned reoperation was 17.2%, and risk of mortality was 3.0%. Risk for complications, reoperation, and readmission did not differ significantly between those who underwent gastric esophageal replacement and those who underwent small bowel or colonic interposition. Median operative time was shorter in the gastric esophageal replacement group (5.2 versus 8.1 h, P = 0.009). Conclusions: Among children in NSQIP-P who underwent esophageal replacement from 2012 to 2018, the risk of 30-d complications, unplanned reoperation, and mortality was relatively frequent and was similar across operative techniques. Opportunities exist to improve preoperative optimization, utilization of blood transfusion services, and infectious complications in the perioperative period irrespective of operative technique. Level of evidence: Level III, retrospective comparative study.
AB - Introduction: The optimal method of esophageal replacement remains controversial. The aim of this study was to evaluate 30-d outcomes of children in the National Surgical Quality Improvement Project Pediatric (NSQIP-P) database who underwent esophageal replacement from 2012 to 2018. Methods: Demographics, comorbidities, and procedural technique was identified in NSQIP-P and reviewed. Thirty-day outcomes were assessed and stratified by gastric pull-up or tube interposition versus small bowel or colonic interposition. Categorical and continuous variables were assessed by Pearson's chi-square, Fisher's exact, and Wilcoxon rank-sum tests, respectively. Multivariate logistic regression was performed to estimate the effects of procedure technique and clinical risk factors on patient outcomes. Results: Of the 99 cases of esophageal replacement included, 52 (52.5%) utilized a gastric conduit, whereas 47 (47.5%) involved small bowel/colonic esophageal interposition. Overall risk of complications was 52.5%, the most common of which were perioperative transfusion (30.3%), surgical site infection (11.1%), and sepsis (9.1%). Risk of unplanned reoperation was 17.2%, and risk of mortality was 3.0%. Risk for complications, reoperation, and readmission did not differ significantly between those who underwent gastric esophageal replacement and those who underwent small bowel or colonic interposition. Median operative time was shorter in the gastric esophageal replacement group (5.2 versus 8.1 h, P = 0.009). Conclusions: Among children in NSQIP-P who underwent esophageal replacement from 2012 to 2018, the risk of 30-d complications, unplanned reoperation, and mortality was relatively frequent and was similar across operative techniques. Opportunities exist to improve preoperative optimization, utilization of blood transfusion services, and infectious complications in the perioperative period irrespective of operative technique. Level of evidence: Level III, retrospective comparative study.
KW - Esophageal atresia
KW - NSQIP
KW - Pediatric surgery
KW - Postoperative complications
KW - Quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85087343407&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85087343407&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2020.05.050
DO - 10.1016/j.jss.2020.05.050
M3 - Article
C2 - 32640406
AN - SCOPUS:85087343407
SN - 0022-4804
VL - 255
SP - 549
EP - 555
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -