Prediction of Postoperative Mortality in Patients with Organ Failure After Gastric Cancer Surgery

• Published in: World journal of surgery 2020-05, Vol.44 (5), p.1569-1577
• Main Authors: Park, Ji-Ho, Lee, Hyuk-Joon, Oh, Seung-Young, Park, Shin-Hoo, Berlth, Felix, Son, Young-Gil, Kim, Tae Han, Huh, Yeon-Ju, Yang, Jun-Young, Lee, Kyung-Goo, Suh, Yun-Suhk, Kong, Seong-Ho, Yang, Han-Kwang
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Acidosis; Acidosis - etiology; Adult; Aged; Aged, 80 and over; APACHE; Cancer; Cardiac Surgery; Failure to Rescue, Health Care; Female; Gastrectomy; Gastrectomy - adverse effects; Gastric cancer; General Surgery; Heart; Heart Failure - etiology; Heart Failure - mortality; Hospital Mortality; Humans; Hypoalbuminemia - etiology; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Organ Dysfunction Scores; Original Scientific Report; Patients; Physiology; Postoperative Complications - etiology; Postoperative Complications - mortality; Postoperative Period; Quality; Respiratory Insufficiency - etiology; Respiratory Insufficiency - mortality; Risk analysis; Risk Factors; Simplified Acute Physiology Score; Stomach Neoplasms - surgery; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-020-05382-9

Background Scarce data are available on the characteristics of postoperative organ failure (POF) and mortality after gastrectomy. We aimed to describe the causes of organ failure and mortality related to gastrectomy for gastric cancer and to identify patients with POF who are at a risk of failure to rescue (FTR). Methods The study examined patients with POF or in-hospital mortality in Seoul National University Hospital between 2005 and 2014. We identified patients at a high risk of FTR by analyzing laboratory findings, complication data, intensive care unit records, and risk scoring including Acute Physiology and Chronic Health Evaluation (APACHE) IV, Sequential Organ Failure Assessment (SOFA) score, and Simplified Acute Physiology Score (SAPS) 3 at ICU admission. Results Among the 7304 patients who underwent gastrectomy, 80 (1.1%) were identified with Clavien–Dindo classification (CDC) grade ≥ IVa. The numbers of patients with CDC grade IVa, IVb, and V were 48 (0.66%), 11 (0.15%), and 21 (0.29%), respectively. Pulmonary failure (43.8%), surgical site complication (27.5%), and cardiac failure (13.8%) were the most common causes of POF and mortality. Cancer progression (100%) and cardiac events (45.5%) showed high FTR rates. In univariate analysis, acidosis, hypoalbuminemia, SOFA, APACHE IV, and SAPS 3 were identified as risk factors for FTR ( P