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Quality Improvement/Clinical Outcomes

E406: Major Morbidity and Mortality Following Total Gastrectomy for Gastric Malignancy: 15 Years of Data from the National Surgical Quality Improvement Program

ePoster Abstract Author(s)

NS

Neha Shafique, MD

Resident
Hospital of the University of Pennsylvania, United States

Submitter(s)

NS

Neha Shafique, MD

Resident
Hospital of the University of Pennsylvania, United States

Author(s)

NS

Neha Shafique, MD

Resident
Hospital of the University of Pennsylvania, United States
NK

Nicholas Kelly, BA

Medical Student
University of Pennsylvania, United States
Gabriella N. Tortorello, MD

Resident
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
John Miura, MD

Surgical oncologist
Hospital of the University of Pennsylvania, United States
GK

Giorgos Karakousis, MD

Surgical oncologist
Hospital of the University of Pennsylvania, United States

Introduction: Gastric cancer represents the third-leading cause of cancer-related death globally. Total gastrectomy has historically carried substantial morbidity and mortality. With an increasing focus on surgical quality and outcomes, we sought to study temporal trends in major morbidity and mortality following total gastrectomy for malignancy in a national cohort.

Methods: The National Surgical Quality Improvement Program (NSQIP) was used to identify patients who underwent total gastrectomy for gastric malignancy from 2007-2021. Joinpoint regression was used to determine annual percent changes (APCs) in thirty-day postoperative major morbidity, mortality, and length of stay (LOS) over time. Major morbidity included any of the following: organ and deep surgical site infection, venous thromboembolism, cardiac event, pneumonia, acute renal failure, sepsis, and respiratory failure.

Results:

3,515 patients who met inclusion criteria. The median age of the cohort was 65 years (interquartile 55-73), 59% were male, and the majority (57.9%) were White.

Overall, 30-day major morbidity was 23%, which did not change significantly over time (APC -1.4, 95% CI -3.4 – 0.58) (Figure 1B), nor were there significant changes in individual morbidities with time. The most common morbidities were organ and deep surgical site infection (10.3%) and pneumonia (8.5%). Mortality rate in the study cohort was 2.7% and did not significantly change between 2007 and 2021 (APC -6.2, 95% CI -13 – 1.1) (Figure 1A). LOS (median 9 days) also did not vary significantly with time (APC -2.3, 95% CI -7.8 – 3.9). Over the study period, there was an increase in the percentage of patients with diabetes (21.6% vs. 11.2%, p< 0.05), BMI ≥30 (31.1% vs. 18.2%, p< 0.05), and ASA IV-V status (11.6% vs. 3.5%, p< 0.05). There was a trend towards a decreased percentage of patients >65, although this did not reach statistical significance (47.3% vs 58%, p=0.06).

Conclusions:

Despite increased efforts to improve surgical quality across cancer procedure types, major morbidity and mortality following total gastrectomy for malignancy remain appreciable and have not significantly changed over the last fifteen years. While this may in part be explained by increased patient co-morbidity, continued efforts should be made to improve patient selection and mitigate post-operative complications to also allow for timely adjuvant therapies.

Learning Objectives:

Understand how quality measures and patient selection can be tracked over time for cancer surgery
Assess surgical outcomes data and identify areas of improvement
Describe common complications and prevalence of those complications following total gastrectomy