title: Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors.
abstract: Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy.
  
  
  
  This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission, and reoperation.
  
  
  
  Three thousand six hundred and seventy-eight patients underwent gastrectomy. A majority of patients had distal gastrectomy (N = 2,799, 76.1 %) and had resection for malignancy (N = 2,316, 63.0 %). Seven hundred and ninety-eight patients (21.7 %) experienced a major complication. Reoperation was required in 290 patients (7.9 %). Thirty-day mortality was 5.2 %. Age (OR = 1.01, 95 % CI = 1.01-1.02, p = 0.001), preoperative malnutrition (OR = 1.65, 95 % CI = 1.35-2.02, p < 0.001), total gastrectomy (OR = 1.63, 95 % CI = 1.31-2.03, p < 0.001), benign indication for resection (OR = 1.60, 95 % CI = 1.29-1.97, p < 0.001), blood transfusion (OR = 2.57, 95 % CI = 2.10-3.13, p < 0.001), and intraoperative placement of a feeding tubes (OR = 1.28, 95 % CI = 1.00-1.62, p = 0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR = 1.23, 95 % CI = 0.99-1.53, p = 0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p < 0.001).
  
  
  
  Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA.|Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA.
authors.forename: Allison N
authors.initials: AN
authors.lastname: Martin
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Deepanjana
authors.initials: D
authors.lastname: Das
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA.|Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA.
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA.|Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Bauer
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA.|Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA.
authors.forename: Reid B
authors.initials: RB
authors.lastname: Adams
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA. vz8h@virginia.edu.|Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA. vz8h@virginia.edu.|Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA. vz8h@virginia.edu.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Zaydfudim
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D065227:Transfusion Reaction
keywords: ACS NSQIP; Gastrectomy; Gastric resection; Morbidity; Surgical outcomes