A group of American researchers assessed morbidity and mortality following gastrectomy for cancer in Veterans Affairs (VA) Medical Centers.
The VA National Surgical Quality Improvement Program prospectively collected data on 708 patients undergoing gastrectomy for cancer, in 123 participating VA medical centers, from 1991 to 1998.
Independent variables included 68 preoperative patient characteristics and 12 intraoperative variables. The dependent variables were 21 defined adverse outcomes and death.
The overall 30-day morbidity and mortality rates were 33% and 8%, respectively.
Significant positive predictors of morbidity included current pneumonia, American Society of Anesthesiologists class IV (threat to life), and partially dependent functional status.
|30-day outcomes after gastrectomy:|
Others included dyspnea on minimal exertion, preoperative transfusion, extended operative time, and increasing age.
Significant positive predictors of mortality included do not resuscitate status, prior stroke, and intraoperative transfusion.
Preoperative weight loss, preoperative transfusion, and elevated preoperative alkaline phosphatase level were also predictors of mortality.
Dr Erik M. Grossmann, of the Saint Louis University School of Medicine and the St Louis VA Medical Center, Missouri, said on behalf of his team, "Risk factors predicting morbidity and mortality rates at VA hospitals after gastrectomy for gastric cancer are reported by using a prospectively collected, multi-institutional database.
"Assigning relative weights to factors associated with adverse outcomes may help improve patient care," he concluded.