title: Outcome-volume relationships and transhiatal esophagectomy: minimizing "failure to rescue".
abstract: BACKGROUND
  The objective of this study is to describe the system and technical factors that enabled our moderate size transhiatal esophagectomy program to achieve low mortality rates.
  
  
  METHODS
  A retrospective chart review was conducted on 200 consecutive patients who underwent transhiatal esophagectomy at Robert Wood Johnson University Hospital. Primary outcomes included operative times, estimated blood loss, frequency and nature of complications, and lengths of stay in the hospital and the intensive care unit.
  
  
  RESULTS
  In general, surgical outcomes tended to improve over the course of this study. We identified decreased operative time, intra-operative blood loss, frequency of complications, and lengths of intensive care unit and hospital stay as the program matured. Through coordinated actions of the surgical and anesthesia teams, all intraoperative injuries were responded to in an effective, emergent fashion and all but one patient was saved. This resulted in an inhospital and 30-day mortality rate of only 0.5%.
  
  
  CONCLUSIONS
  Our study suggests that a dual attending approach, focus on avoiding "failure to rescue", increased volume, and a surgeon driven commitment to quality improvement may lead to low mortality rates after transhiatal esophagectomy.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, New Jersey 08903-2601 USA.
authors.forename: Renee L
authors.initials: RL
authors.lastname: Arlow
authors.affiliation: Department of Biostatistics, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, New Jersey 08903-2601 USA.
authors.forename: Dirk F
authors.initials: DF
authors.lastname: Moore
authors.affiliation: Department of Biostatistics, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, New Jersey 08903-2601 USA.
authors.forename: Chunxia
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Surgery, Section of Thoracic Surgery, Rutgers Robert Wood Johnson Medical School and The Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, New Jersey 08903-2601 USA.
authors.forename: John
authors.initials: J
authors.lastname: Langenfeld
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, New Jersey 08903-2601 USA.
authors.forename: David A
authors.initials: DA
authors.lastname: August
keywords: Esophageal cancer; Esophagectomy; Failure to rescue; Outcome-volume relationships; Postoperative complication; Quality improvement