Socioeconomic Deprivation Is Not Associated with Outcomes after Esophagectomy at a German High-Volume Center.
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ABSTRACT:
SUBMITTER: Kemper M
PROVIDER: S-EPMC10216220 | biostudies-literature | 2023 May
REPOSITORIES: biostudies-literature
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Socioeconomic Deprivation Is Not Associated with Outcomes after Esophagectomy at a German High-Volume Center.
Kemper Marius M Zagorski Jana J Wagner Jonas J Graß Julia-Kristin JK Izbicki Jakob R JR Melling Nathaniel N Wolter Stefan S Reeh Matthias M
Cancers 20230518 10
In Germany, socioeconomically deprived citizens more often develop esophageal carcinoma, since typical risk factors follow the social gradient. Therefore, we hypothesized that socioeconomic deprivation might also be associated with advanced tumor stages and comorbidities at the time of surgery. As a consequence, socioeconomic deprivation may be related to postoperative complications and reduced overall survival. Therefore, 310 patients who had undergone esophagectomy for cancer in curative inten ...[more]
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Project description:IntroductionTransthoracic esophagectomy is a highly complex and sophisticated procedure with high morbidity rates and a significant mortality. Surgical access has consistently become less invasive, transitioning from open esophagectomy to hybrid esophagectomy (HE) then to totally minimally invasive esophagectomy (MIE), and most recently to robot-assisted minimally invasive esophagectomy (RAMIE), with each step demonstrating improved patient outcomes. Aim of this study with more than 600 patients is to complete a propensity-score matched comparison of postoperative short-term outcomes after highly standardized RAMIE vs. HE in a European high volume center.Patients and methodsSix hundred and eleven patients that underwent transthoracic Ivor-Lewis esophagectomy for esophageal cancer between May 2016 and May 2021 were included in the study. In January 2019, we implemented an updated robotic standardized anastomotic technique using a circular stapler and ICG (indocyanine green) for RAMIE cases. Data were retrospectively analyzed from a prospectively maintained IRB-approved database. Outcomes of patients undergoing standardized RAMIE from January 2019 to May 2021 were compared to our overall cohort from May 2016-April 2021 (HE) after a propensity-score matching analysis was performed.ResultsSix hundred and eleven patients were analyzed. 107 patients underwent RAMIE. Of these, a total of 76 patients underwent a robotic thoracic reconstruction using the updated standardized circular stapled anastomosis (RAMIE group). A total of 535 patients underwent HE (Hybrid group). Seventy patients were propensity-score matched in each group and analysis revealed no statistically significant differences in baseline characteristics. RAMIE patients had a significantly shorter ICU stay (p = 0.0218). Significantly more patients had no postoperative complications (Clavien Dindo 0) in the RAMIE group [47.1% vs. 27.1% in the HE group (p = 0.0225)]. No difference was seen in lymph node yield and R0 resection rates. Anastomotic leakage rates when matched were 14.3% in the hybrid group vs. 4.3% in the RAMIE group (p = 0.07).ConclusionOur analysis confirms the safety and feasibility of RAMIE and HE in a large cohort after propensity score matching. A regular postoperative course (Clavien-Dindo 0) and a shorter ICU stay were seen significantly more often after RAMIE compared to HE. Furthermore it shows that both procedures provide excellent short-term oncologic outcomes, regarding lymph node harvest and R0 resection rates. A randomized controlled trial comparing RAMIE and HE is still pending and will hopefully contribute to ongoing discussions.
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Project description:BackgroundPatients are increasingly traveling greater distances to receive care at high-volume centers. The effect of travel distance on patient-reported outcomes after hip resurfacing arthroplasty has not been described.MethodsPatients undergoing HRA by a single surgeon from January 2007 to April 2018 with minimum 2-year follow-up were reviewed retrospectively. Five hundred ninety-nine patients were identified and divided into 2 cohorts: home-to-hospital distance >100 miles and ≤100 miles from our institution. Preoperative and 2-year postoperative patient-reported outcome measures (PROMs) were assessed, including the modified Harris Hip Score and Hip disability and Osteoarthritis Outcome Score. The minimal clinically important difference (MCID) for each PROM was calculated using the distribution-based method. Chi-square tests were used for univariate comparison. Poisson regressions controlling for demographic variables were performed to determine the effect of travel distance on whether patients achieved the MCID. Multivariate linear regressions were used to determine association between distance and improvement in PROMs.ResultsA total of 599 patients met criteria for inclusion. There were 113 (18.9%) with a home-to-hospital distance >100 miles and 486 (81.1%) with distance ≤100 miles. Age was the only demographic factor different between these groups (mean: 1.1-year difference, P < .001). There were no significant differences in reaching the MCID on any PROM between these groups. Multivariate linear regressions revealed no associations between travel distance and improvement in PROMs.ConclusionsTravel distance to a high-volume center did not affect 2-year patient-reported outcomes or rate of achieving the MCID in patients undergoing hip resurfacing arthroplasty.
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Project description:Rationale & objectivesRecent data demonstrate that center volume is not a factor in the outcomes of adult kidney transplant recipients. This study assessed whether center volume affects graft survival in pediatric patients who received a kidney transplant.Study designCase-cohort study.Setting & participantsKidney transplantation centers, recipients younger than 18 years.ResultsData were retrieved from the Scientific Registry of Transplant Recipients for transplantations performed July 1, 2010, to June 30, 2015, and the Organ Procurement and Transplantation Network for transplantations performed January 1, 2010, to December 30, 2015. Center volume was divided into 3 groups: low (<4 per year), intermediate (4-8 per year), and high (>8 per year). The primary outcome was 3-year graft survival rate. Outcomes were reviewed in 115 centers that performed 3,762 transplantations. There were no substantive differences in sex, age, ethnicity, diagnosis, and kidney donor profile index score in the 3 transplantation center volume categories. During the 5-year period (July 1, 2010, to June 30, 2015), 3-year graft survival in centers with low, intermediate, and high volumes were 88.4%, 90.3%, and 92.1%, respectively; P = 0.02. Although outcomes for deceased donor kidney recipients were similar in the 3 volume categories, outcomes in patients who received a living kidney donation were better in the high-volume centers. Low household income was associated with poorer outcomes. However, 3-year graft survival was similar in the 3 center volume categories in high and low mean household income states.LimitationsLack of information for complications and individual family household income of recipients.ConclusionsTransplantation outcomes are worse in pediatric patients treated at lower-volume centers. The difference was more pronounced for patients receiving living versus deceased donor kidneys. The distribution of household income in pediatric transplant recipients may also be a factor that contributes to lower 3-year graft survival in low-volume centers.
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