title: Failure to rescue patients after reintervention in gastroesophageal cancer surgery in England.
abstract: OBJECTIVE
  Gastroesophageal cancer resections are associated with significant reintervention and perioperative mortality rates.
  
  
  OBJECTIVE
  To compare outcomes following operative and nonoperative reinterventions between high- and low-mortality gastroesophageal cancer surgical units in England.
  
  
  METHODS
  All elective esophageal and gastric resections for cancer between 2000 and 2010 in English public hospitals were identified from a national administrative database. Units were divided into low- and high-mortality units (LMUs and HMUs, respectively) using a threshold of 5% or less for 30-day adjusted mortality. The groups were compared for reoperations and nonoperative reinterventions following complications.
  
  
  METHODS
  Both LMUs and HMUs.
  
  
  METHODS
  Patients who underwent esophageal and gastric resections for cancer.
  
  
  METHODS
  Elective esophageal and gastric resections for cancer, with reoperations and nonoperative reinterventions following complications.
  
  
  METHODS
  Failure to rescue is defined as the death of a patient following a complication; failure to rescue-surgical is defined as the death of a patient following reoperation for a surgical complication.
  
  
  RESULTS
  There were 14 955 esophagectomies and 10 671 gastrectomies performed in 141 units. For gastroesophageal resections combined, adjusted mortality rates were 3.0% and 8.3% (P < .001) for LMUs and HMUs, respectively. Complications rates preceding reoperation were similar (5.4% for LMUs vs. 4.9% for HMUs; P = .11). The failure to rescue-surgical rates were lower in LMUs than in HMUs (15.3% vs. 24.1%; P < .001). The LMUs performed more nonoperative reinterventions than the HMUs did (6.7% vs. 4.7%; P < .001), with more patients surviving in LMUs than in HMUs (failure to rescue rate, 7.0% vs. 12.5%; P < .001). Overall, LMUs reintervened more than HMUs did (12.2% vs 9.6%; P < .001), and LMUs had lower failure to rescue rates following reintervention than HMUs did (9.0% vs. 18.3%; P = .001). All P values stated refer to 2-sided values.
  
  
  CONCLUSIONS
  Overall, LMUs were more likely to reintervene and rescue patients following gastroesophageal cancer resections in England. Patients were more likely to survive following both reoperations and nonsurgical interventions in LMUs.
authors.affiliation: Department of Surgery and Cancer, Faculty of Medicine, St Mary’s Hospital.
authors.forename: Alex M
authors.initials: AM
authors.lastname: Almoudaris
authors.forename: Ravikrishna
authors.initials: R
authors.lastname: Mamidanna
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.forename: Paul
authors.initials: P
authors.lastname: Aylin
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004739:England; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy / Q000401:mortality*; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome