Open AccessPrediction of Postoperative Mortality in Patients with Organ Failure After Gastric Cancer Surgery
Author(s) -
Park JiHo,
Lee HyukJoon,
Oh SeungYoung,
Park ShinHoo,
Berlth Felix,
Son YoungGil,
Kim Tae Han,
Huh YeonJu,
Yang JunYoung,
Lee KyungGoo,
Suh YunSuhk,
Kong SeongHo,
Yang HanKwang
Publication year - 2020
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-020-05382-9
Subject(s) - medicine , cardiac surgery , intensive care unit , vascular surgery , abdominal surgery , cancer , gastrectomy , sofa score , cardiothoracic surgery , hypoalbuminemia , univariate analysis , complication , heart failure , surgery , multivariate analysis
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 < 0.05). Finally, SAPS 3 was identified as an independent predictive factor for FTR. Conclusions Cancer progression and acute cardiac failure were the most lethal causes of FTR. SAPS 3 is an independent predictor of FTR among POF patients after gastrectomy.