Abstract
BackgroundLittle is known about how early postoperative complications after oesophagectomy for cancer influence healthcare utilisation in the long-term. We hypothesised that these complications also increase healthcare utilisation long after the recovery period.MethodsThis was a prospective, nationwide Swedish population-based cohort study of patients who underwent curatively intended oesophagectomy for cancer in 2001-2005 and survived at least 1 year postoperatively (n = 390). Total days of in-hospitalisation, number of hospitalisations and number of visits to the outpatient clinic within 5 years of surgery were analysed using quasi-Poisson models with adjustment for patient, tumour and treatment characteristics and are expressed as incidence rate ratios (IRR) and 95% confidence intervals (CI).ResultsThere was an increased in-hospitalisation period 1-5 years after surgery in patients with more than 1 complication (IRR 1.5, 95% CI 1.0-2.4). The IRR for the number of hospitalisations by number of complications was 1.1 (95% CI 0.7-1.6), and 1.2 (95% CI 0.9-1.6) for number of outpatient visits in patients with more than 1 complication. The IRR for in-hospitalisation period 1-5 years following oesophagectomy was 1.8 (95% CI 1.0-3.0) for patients with anastomotic insufficiency and 1.5 (95% CI 0.9-2.5) for patients with cardiovascular or cerebrovascular complications. We found no association with number of hospitalisations (IRR 1.2, 95% CI 0.7-2.0) or number of outpatient visits (IRR 1.3, 95% CI 0.9-1.7) after anastomotic insufficiency, or after cardiovascular or cerebrovascular complications (IRR 1.2, 95% CI 0.7-1.9) and (IRR 1.1, 95% CI 0.8-1.5) respectively.ConclusionThis study showed an increased total in-hospitalisation period 1-5 years after oesophagectomy for cancer in patients with postoperative complications, particularly following anastomotic insufficiency.
Highlights
The incidence of oesophageal cancer is increasing in many Western countries.[1]
There was an increased in-hospitalisation period 1-5 years after surgery in patients with more than 1 complication (IRR 1.5, 95% confidence intervals (CI) 1.0-2.4)
The incidence rate ratios (IRR) for the number of hospitalisations by number of complications was 1.1, and 1.2 for number of outpatient visits in patients with more than 1 complication
Summary
The incidence of oesophageal cancer is increasing in many Western countries.[1]. The curatively intended treatment for oesophageal cancer typically includes oesophagectomy, an extraordinarily extensive procedure which holds a 30% to 50% risk of serious postoperative complications, and a 5% risk of in-hospital mortality.[1,2] The overall prognosis for patients with oesophageal cancer is slowly improving, but the relative overall 5-year survival is still only 10–15% and the postoperative 5-year survival 30–55%.[2]. The main aim of this study was to assess the influence of early major postoperative complications after oesophagectomy for cancer on postoperative healthcare utilisation 1 to 5 years after surgery by using a prospective population-based cohort, taking into account any influence of major patient and tumour characteristics. Little is known about how early postoperative complications after oesophagectomy for cancer influence healthcare utilisation in the long-term. We hypothesised that these complications increase healthcare utilisation long after the recovery period
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