Oral Presentation AANZGOSA-SUGSS ASM 2024

Regional outcome differences following oesophagectomy and the impact of Centralisation across Australia and New Zealand. (110305)

Josipa Petric 1 , Muktar Ahmed 1 , Maziar Navidi 2 , David Pilcher 3 , Shailesh Bihari 1 4 , Norma Bulamu 1 , Tim Bright 1 2 , David Watson 1 2
  1. Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
  2. Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
  3. Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
  4. Intensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia

Introduction:

In international studies, higher-volume hospitals deliver better outcomes and decreased mortality following oesophagectomy. There is emerging data which suggests this also applies in Australia. This study investigated differences in hospital outcomes and patterns of care for oesophagectomy across Australian and New Zealand (ANZ) regions.

Methods:

As standard care following esophagectomy in ANZ is admission to an intensive care unit (ICU), the ANZ Intensive Care Society Adult Patient Database was used to identify patients undergoing esophagectomy in ANZ from 2012-22. Primary outcomes evaluated were in-hospital mortality and hospital volumes across regions. Secondary outcomes included ICU and hospital length of stay.

Results:

4681 patients underwent esophagectomy in 143 hospitals. Overall in-hospital mortality was 3.5%, varying from 1.5% to 5.9% (p < 0.001) between regions. Eastern Australian States were more likely to undertake surgery in private hospitals (p < 0.001), and with the exception of the Northern Territory (NT), Victoria had the highest percentage of operations performed in a rural/regional hospital (p<0.001). South Australia had the lowest ICU readmission rates and the highest rates of inotrope usage (p <0.001). The highest rates of ventilation were in the NT, followed by New South Wales (NSW) and Tasmania (p <0.001). NT and Victoria had the longest hospital stays (p<0.001) and the shortest ICU stays were in Western Australia (p<0.001). Centralisation to higher volume hospitals differed significantly between regions.

Conclusions:

In-hospital mortality following oesophagectomy varied significantly different between regions. Patterns of care and volume are likely to impact this outcome.