Early complications following oesophagectomy for cancer in relation to long-term healthcare utilisation : a prospective population-based cohort study

Doorakkers, Eva; Konings, Peter; Mattsson, Fredrik; Lagergren, Jesper; Brusselaers, Nele

doi:10.1371/JOURNAL.PONE.0121080

Title

Early complications following oesophagectomy for cancer in relation to long-term healthcare utilisation : a prospective population-based cohort study

Author

Doorakkers, Eva

Konings, Peter

Mattsson, Fredrik

Lagergren, Jesper

Brusselaers, Nele

Abstract

Background Little is known about how early postoperative complications after oesophagectomy for cancer influence healthcare utilisation in the long-term. We hypothesised that these complications also increase healthcare utilisation long after the recovery period. Methods This was a prospective, nationwide Swedish population-based cohort study of patients who underwent curatively intended oesophagectomy for cancer in 2001-2005 and survived at least 1 year postoperatively (n = 390). Total days of in-hospitalisation, number of hospitalisations and number of visits to the outpatient clinic within 5 years of surgery were analysed using quasi-Poisson models with adjustment for patient, tumour and treatment characteristics and are expressed as incidence rate ratios (IRR) and 95% confidence intervals (CI). Results There was an increased in-hospitalisation period 1-5 years after surgery in patients with more than 1 complication (IRR 1.5, 95% CI 1.0-2.4). The IRR for the number of hospitalisations by number of complications was 1.1 (95% CI 0.7-1.6), and 1.2 (95% CI 0.9-1.6) for number of outpatient visits in patients with more than 1 complication. The IRR for in-hospitalisation period 1-5 years following oesophagectomy was 1.8 (95% CI 1.0-3.0) for patients with anastomotic insufficiency and 1.5 (95% CI 0.9-2.5) for patients with cardiovascular or cerebrovascular complications. We found no association with number of hospitalisations (IRR 1.2, 95% CI 0.7-2.0) or number of outpatient visits (IRR 1.3, 95% CI 0.9-1.7) after anastomotic insufficiency, or after cardiovascular or cerebrovascular complications (IRR 1.2, 95% CI 0.7-1.9) and (IRR 1.1, 95% CI 0.8-1.5) respectively. Conclusion This study showed an increased total in-hospitalisation period 1-5 years after oesophagectomy for cancer in patients with postoperative complications, particularly following anastomotic insufficiency.

Language

English

Source (journal)

PLoS ONE

Publication

2015

ISSN

1932-6203

DOI

10.1371/JOURNAL.PONE.0121080

Volume/pages

10 :3 (2015) , 10 p.