Dataset Information

Reoperation after oesophageal cancer surgery in relation to long-term survival: a population-based cohort study.

ABSTRACT:

Objectives

The influence of reoperation on long-term prognosis is unknown. In this large population-based cohort study, it was aimed to investigate the influence of a reoperation within 30 days of oesophageal cancer resection on survival even after excluding the initial postoperative period.

Design

This was a nationwide population-based retrospective cohort study.

Setting

All hospitals performing oesophageal cancer resections during the study period (1987-2010) in Sweden.

Participants

Patients operated for oesophageal cancer with curative intent in 1987-2010.

Primary and secondary outcomes

Adjusted HRs of all cause, early and late mortality up to 5 years after reoperation following oesophageal cancer resection.

Results

Among 1822 included patients, the 200 (11%) who were reoperated had a 27% increased HR of all-cause mortality (adjusted HR 1.27, 95% CI 1.05 to 1.53) and 28% increased HR of disease-specific mortality (adjusted HR 1.28, 95% CI 1.04 to 1.59), compared to those not reoperated. Reoperation for anastomotic insufficiency in particular was followed by an increased mortality (adjusted HR 1.82, 95% CI 1.19 to 2.76).

Conclusions

This large and population-based nationwide cohort study shows that reoperation within 30 days after primary oesophageal resection was associated with increased mortality, even after excluding the initial 3 months after surgery. This finding stresses the need to consider any actions that might prevent complications and reoperation after oesophageal cancer resection.

SUBMITTER: van der Schaaf M

PROVIDER: S-EPMC3963069 | biostudies-literature | 2014 Mar

REPOSITORIES: biostudies-literature

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Publications

Reoperation after oesophageal cancer surgery in relation to long-term survival: a population-based cohort study.

van der Schaaf Maartje M Derogar Maryam M Johar Asif A Rutegård Martin M Gossage James J Mason Robert R Lagergren Pernilla P Lagergren Jesper J

BMJ open 20140320 3

<h4>Objectives</h4>The influence of reoperation on long-term prognosis is unknown. In this large population-based cohort study, it was aimed to investigate the influence of a reoperation within 30 days of oesophageal cancer resection on survival even after excluding the initial postoperative period.<h4>Design</h4>This was a nationwide population-based retrospective cohort study.<h4>Setting</h4>All hospitals performing oesophageal cancer resections during the study period (1987-2010) in Sweden.<h ...[more]

PMID: 24650808

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Project description:ObjectiveTo provide clinicians and patients with accurate risk estimates of serious adverse events after common elective shoulder arthroscopic procedures, including reoperation within one year.DesignPopulation based cohort study.SettingHospital Episode Statistics for NHS England, including civil registration mortality data from the Office for National Statistics.Participants288 250 arthroscopic shoulder procedures performed in 261 248 patients aged ≥16 years between 1 April 2009 and 31 March 2017. Elective procedures were grouped into subacromial decompression, rotator cuff repair, acromioclavicular joint excision, glenohumeral stabilisation, and frozen shoulder release.Main outcome measuresThe primary outcomes were rates of serious adverse events (mortality, pulmonary embolism, pneumonia, myocardial infarction, acute kidney injury, stroke, and urinary tract infection) requiring inpatient care within 90 days post-surgery. Secondary outcomes were specific adverse event rates at 90 days, and reoperations (including for deep infection) within one year.ResultsThe overall rate of complications within 90 days after arthroscopic shoulder surgery (including reoperation) was low at 1.2% (95% confidence interval 1.2% to 1.3%), with one in 81 patients at risk, and varied according to type of procedure, from 0.6% (0.5% to 0.8%) for glenohumeral stabilisation to 1.7% (1.5% to 1.8%) for frozen shoulder release. After adjustment for age, comorbidities, and sex, no effect of procedure type was observed. Pneumonia was the most common adverse event (0.3%, 0.3% to 0.4%), with one in 303 patients at risk. Pulmonary embolic events were rare, at 0.1% (0.1% to 0.1%), with one in 1428 patients at risk. At one year, the overall rate for reoperation was 3.8% (3.8% to 3.9%), with one in 26 patients at risk, ranging from 2.7% (2.5% to 3.0%) for glenohumeral stabilisation to 5.7% (5.4% to 6.1%) for frozen shoulder release. The overall rate of further surgery for deep infection was low, at 0.1% (0.1% to 0.1%), with one in 1111 patients at risk, but was higher after rotator cuff repair (0.2%, 0.2% to 0.2%), with one in 526 patients at risk. Over the study period the number of arthroscopic shoulder procedures increased, except for subacromial decompression, which decreased.ConclusionsThe findings of this study suggest that risks of serious adverse events associated with common shoulder arthroscopy procedures are low. Nevertheless, serious complications do occur, and include the risk of reoperation in one in 26 patients within one year.Study registrationClinical.Trialsgov NCT03573765.

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Dataset Information

Reoperation after oesophageal cancer surgery in relation to long-term survival: a population-based cohort study.

Objectives

Design

Setting

Participants

Primary and secondary outcomes

Results

Conclusions

Publications

Reoperation after oesophageal cancer surgery in relation to long-term survival: a population-based cohort study.

Similar Datasets

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