title: Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database.
abstract: BACKGROUND
  Frequent perioperative morbidity and mortality have been observed in randomized surgical studies for gastric cancer, but specific patient factors associated with morbidity and mortality after total gastrectomy have not been well characterized.
  
  
  METHODS
  We queried the American College of Surgeons National Surgical Quality Improvement Program database (2005-2011) for all patients with a gastric neoplasm undergoing total gastrectomy. Univariate and multivariate logistic regression analyses were performed to identify factors associated with an increased risk of morbidity or mortality.
  
  
  RESULTS
  In 1,165 patients undergoing total gastrectomy, 416 patients (36%) experienced a complication, and 55 died (4.7%) within 30 days of operation. In a reduced multivariate model, age >70 years, preoperative weight loss, splenectomy, and pancreatectomy were associated with morbidity, whereas age >70 years, weight loss, albumin <3 g/dL, and pancreatectomy were associated with mortality (P < .05 each). The number of present preoperative risk factors stratified morbidity from 26 to 46%, with an adjacent organ resection (splenectomy, pancreatectomy) associated with 56% morbidity. Similarly, mortality rates ranged from 0.4% in those without risk factors to 5 of 9 patients with all three preoperative factors present. Patients undergoing pancreatectomy had a 13% mortality rate.
  
  
  CONCLUSIONS
  Total gastrectomy for malignancy is associated with substantial morbidity and mortality. Identification of high-risk factors may allow more rational patient selection or sequencing of therapy.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Bartlett
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA. Electronic address: Robert.Roses@uphs.upenn.edu.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Drebin
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Fraker
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality* / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D018579:Patient Selection; D058996:Quality Improvement; D012307:Risk Factors; D012955:Societies, Medical; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D014481:United States / Q000453:epidemiology