TY - JOUR
T1 - Hospital Variation in Feeding Jejunostomy Policy for Minimally Invasive Esophagectomy
T2 - A Nationwide Cohort Study
AU - Visser, Maurits R.
AU - Straatman, Jennifer
AU - Voeten, Daan M.
AU - Gisbertz, Suzanne S.
AU - Ruurda, Jelle. P.
AU - Luyer, Misha D. P.
AU - On behalf of the Dutch Upper Gastrointestinal Cancer Audit (DUCA) group
AU - van der Sluis, Pieter C.
AU - van der Peet, Donald L.
AU - van Berge Henegouwen, Mark I.
AU - van Hillegersberg, Richard
N1 - Publisher Copyright: © 2022 by the authors.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - The purpose of this study was to investigate hospital variation in the placement, surgical techniques, and safety of feeding jejunostomies (FJ) during minimally invasive esophagectomy (MIE) in the Netherlands. This nationwide cohort study analyzed patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) that underwent MIE for cancer. Hospital variation in FJ placement rates were investigated using case-mix corrected funnel plots. Short-term outcomes were compared between patients with and without FJ using multilevel multivariable logistic regression analysis. The incidence of FJ-related complications was described and compared between hospitals performing routine and non-routine placement (≥90%–<90% of patients). Between 2018–2020, an FJ was placed in 1481/1811 (81.8%) patients. Rates ranged from 11–100% among hospitals. More patients were discharged within 10 days (median hospital stay) without FJ compared to patients with FJ (64.5% vs. 50.4%; OR: 0.62, 95% CI: 0.42–0.90). FJ-related complications occurred in 45 (3%) patients, of whom 23 (1.6%) experienced severe complications (≥Clavien–Dindo IIIa). The FJ-related complication rate was 13.7% in hospitals not routinely placing FJs vs. 1.7% in hospitals performing routine FJ placement (p < 0.001). Significant hospital variation in the use of FJs after MIE exists in the Netherlands. No effect of FJs on complications was observed. FJs can be placed safely, with lower FJ-related complication rates, in centers performing routine placement.
AB - The purpose of this study was to investigate hospital variation in the placement, surgical techniques, and safety of feeding jejunostomies (FJ) during minimally invasive esophagectomy (MIE) in the Netherlands. This nationwide cohort study analyzed patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) that underwent MIE for cancer. Hospital variation in FJ placement rates were investigated using case-mix corrected funnel plots. Short-term outcomes were compared between patients with and without FJ using multilevel multivariable logistic regression analysis. The incidence of FJ-related complications was described and compared between hospitals performing routine and non-routine placement (≥90%–<90% of patients). Between 2018–2020, an FJ was placed in 1481/1811 (81.8%) patients. Rates ranged from 11–100% among hospitals. More patients were discharged within 10 days (median hospital stay) without FJ compared to patients with FJ (64.5% vs. 50.4%; OR: 0.62, 95% CI: 0.42–0.90). FJ-related complications occurred in 45 (3%) patients, of whom 23 (1.6%) experienced severe complications (≥Clavien–Dindo IIIa). The FJ-related complication rate was 13.7% in hospitals not routinely placing FJs vs. 1.7% in hospitals performing routine FJ placement (p < 0.001). Significant hospital variation in the use of FJs after MIE exists in the Netherlands. No effect of FJs on complications was observed. FJs can be placed safely, with lower FJ-related complication rates, in centers performing routine placement.
KW - complications
KW - esophageal carcinoma
KW - feeding jejunostomy
KW - minimally invasive esophagectomy
UR - http://www.scopus.com/inward/record.url?scp=85145890808&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/nu15010154
DO - https://doi.org/10.3390/nu15010154
M3 - Article
C2 - 36615812
SN - 2072-6643
VL - 15
JO - NUTRIENTS
JF - NUTRIENTS
IS - 1
M1 - 154
ER -