Generic Portal

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 - 10.3390/nu15010154

DO - 10.3390/nu15010154

M3 - Article

C2 - 36615812

VL - 15

JO - Nutrients

JF - Nutrients

SN - 2072-6643

IS - 1

M1 - 154

ER -