Risk factors associated with missing post-esophagectomy hospital milestones

Our institution utilizes an esophagectomy pathway to guide postoperative management. Our aim was to identify risk factors associated with missing pathway goals. Retrospective review of esophagectomies from 2010 to 2015. Multivariate logistic regression models identified risk factors for missing post...

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Bibliographic Details
Published in:	The American journal of surgery Vol. 215; no. 5; pp. 953 - 957
Main Authors:	Siegal MD, Steve R., Dolan, James P., Dewey MS, Elizabeth N., Parmar, Abhisek D., Petcu NP, Aura, Tieu MD, Brandon H., Schipper MD, Paul H., Hunter MD, John G.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-05-2018 Elsevier Limited
Subjects:	Adult Aged Aged, 80 and over Body mass Body Mass Index Clinical pathways Comorbidity Confidence intervals Critical Pathways Decision making Esophageal cancer Esophageal Neoplasms - surgery Esophagectomy Esophagus Female Gastrointestinal surgery Hospital costs Humans Identification methods Male Middle Aged Morbidity Mortality Neoplasm Staging Oesophageal cancer Oesophagectomy Operative Time Patients Postoperative Complications - prevention & control Ratios Regression analysis Regression models Retrospective Studies Risk analysis Risk Factors Risk management Surgery Tobacco Tobacco Use Disorder - complications Esophagectomy Oesophageal cancer Clinical pathways Oesophagectomy Esophageal cancer Risk factors
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Summary:	Our institution utilizes an esophagectomy pathway to guide postoperative management. Our aim was to identify risk factors associated with missing pathway goals. Retrospective review of esophagectomies from 2010 to 2015. Multivariate logistic regression models identified risk factors for missing postoperative milestones prior to discharge. Odds ratios of variables affecting goals were calculated. Of the195 esophagectomies, the most common risk factor for missing milestones was BMI, followed by operating room time, clinical stage, tobacco pack-years, and open surgical approach. Missing any milestone on the expected postoperative day significantly increase the odds of missing a future milestone, regardless of other risk factors. We have identified specific patient and operative factors that increase the risk of missing post-esophagectomy goals on time. Early identification of at-risk patients allows for pathway modification to avoid adverse outcomes and prolonged hospitalization. Analysis of meeting milestones early may allow for creation of accelerated pathways. •Open surgery, BMI, tobacco use, stage, and surgery duration prolong hospitalization after esophagectomy.•Identification of at-risk patients may help alter postoperative care to avoid adverse outcomes.•Patients without risk factors may benefit from shortened postoperative hospitalizations.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9610 1879-1883
DOI:	10.1016/j.amjsurg.2018.01.036