Introduction
Methods
Study design
Patient population and treatment
Predictors and study outcomes
Statistical analysis
No. (%) | Initial missing values (%) | |
---|---|---|
Patient characteristics | ||
Age, years (mean ± SD) | 68.6 ± 11.7 | 1 (< 1%) |
BMI, kg/m2 (mean ± SD) | 25.2 ± 4.5 | 44 (2%) |
Gender (% male) | 1343 (62) | 0 (0%) |
ASA-classification | 10 (1%) | |
I | 303 (14) | |
II | 1225 (56) | |
III | 627 (29) | |
IV | 21 (1) | |
Comorbidities | 0 (0%) | |
Asthma/COPD | 270 (12) | |
Coronary artery diseasea | 253 (12) | |
History of myocardial infarction | 175 (8) | |
History of arrhythmia | 302 (14) | |
Hypertension | 763 (35) | |
Peripheral vascular disease | 101 (5) | |
Diabetes mellitus | 368 (17) | |
History of CVA | 103 (5) | |
History of thromboembolic events | 157 (7) | |
Endocrine disorder | 131 (6) | |
Previous abdominal or thoracic surgery | 868 (40) | 0 (0%) |
Tumor characteristics | ||
cT-stage | 515 (23%) | |
T1 | 202 (9) | |
T2 | 675 (31) | |
T3 | 1169 (54) | |
T4 | 130 (6) | |
cN-stage | 235 (11%) | |
N0 | 1287 (59) | |
N1 | 583 (27) | |
N2 | 192 (9) | |
N3 | 44 (2) | |
Nx | 70 (3) | |
Treatment characteristics | ||
Neoadjuvant treatment | 1339 (62) | 3 (< 1%) |
Resection type | 0 (0%) | |
Total gastrectomy | 905 (42) | |
Subtotal gastrectomy | 1271 (58) | |
Surgical approach (% open procedure) | 1352 (62) | 0 (0%) |
Conversion | 87 (4) | 0 (0%) |
Tumor location | 53 (2%) | |
Fundus | 165 (8) | |
Corpus | 691 (32) | |
Antrum | 959 (44) | |
Pylorus | 189 (9) | |
Whole stomach | 98 (5) | |
Other | 74 (3) |
Population-attributable fraction (PAF)
Results
Study population
Postoperative outcomes
No. (%) | Initial missing valuesl | |
---|---|---|
Postoperative complications | ||
Pulmonary complicationa | 321 (15) | 0 |
Anastomotic leakageb | 154 (7) | 0 |
Cardiac complicationc | 122 (6) | 0 |
Acute delirium | 103 (5) | 0 |
Abscess | 85 (4) | 0 |
Wound infection | 93 (4) | 0 |
Urological complicationd | 80 (4) | 0 |
Thromboembolic complicatione | 32 (2) | 0 |
Chyle leakage | 38 (2) | 0 |
Postoperative bleeding | 35 (2) | 0 |
Bowel injury | 26 (1) | 0 |
Pancreatitis | 10 (< 1) | 0 |
Clinical outcomes | ||
Postoperative mortalityf | 118 (5) | 0 |
Duration of hospital stay (days)g | 9 (7–13) | 17 |
Prolonged hospitalizationh | 484 (22) | 17 |
Re-interventioni | 344 (16) | 0 |
Reoperationj | 247 (11) | 0 |
Hospital readmissionk | 259 (12) | 0 |
Postoperative complication | No. died/survived (% died) | Risk-adjusted associationa | Risk-adjusted PAFb | ||
---|---|---|---|---|---|
Adjusted relative risk (95%CI) | p value | PAF% (95% CI) | p value | ||
Pulmonary complication | 49/272 (15) | 3.02 (2.06–4.41) | < 0.001 | 21.6 (10.5–32.7) | < 0.001 |
Anastomotic leakage | 45/109 (29) | 6.32 (4.18–9.49) | < 0.001 | 29.2 (19.3–39.1) | < 0.001 |
Cardiac complication | 25/97 (21) | 3.10 (1.91–4.87) | < 0.001 | 8.9 (1.1–1.7) | 0.025 |
Acute delirium | 14/89 (14) | 1.71 (0.92–2.95) | 0.054 | – | – |
Abscess | 11/74 (13) | 2.30 (1.15–4.16) | 0.003 | 0.3 (− 5.2–5.9) | 0.902 |
Wound infection | 10/83 (11) | 1.64 (0.79–3.02) | 0.119 | – | – |
Urological complication | 8/72 (10) | 1.41 (0.62–2.76) | 0.362 | – | – |
Thromboembolic complication | 5/27 (16) | 2.82 (0.97–6.49) | 0.034 | 0.2 (− 3.7–4.1) | 0.921 |
Chyle leakage | 2/36 (5) | 0.93 (0.15–2.97) | 0.911 | – | – |
Post–operative bleeding | 7/28 (20) | 3.53 (1.47–7.20) | < 0.001 | 2.7 (− 1.1–6.6) | 0.162 |
Bowel injury | 8/18 (31) | 5.27 (2.27–10.67) | < 0.001 | 4.2 (0.2–8.2) | 0.036 |
Postoperative complication | No. with/without prolonged stay (% prolonged) | Risk-adjusted associationa | Risk-adjusted PAFb | ||
---|---|---|---|---|---|
Adjusted relative risk (95% CI) | p value | PAF% (95% CI) | p value | ||
Pulmonary complication | 162/159 (50) | 2.78 (2.29–3.38) | < 0.001 | 14.7 (11.0–18.8) | < 0.001 |
Anastomotic leakage | 112/42 (73) | 3.94 (3.12–4.93) | < 0.001 | 12.9 (9.7–16.0) | < 0.001 |
Cardiac complication | 62/60 (51) | 2.22 (1.67–2.91) | < 0.001 | 2.8 (0.4–5.2) | 0.021 |
Acute delirium | 52/51 (51) | 2.26 (1.66–3.01) | < 0.001 | 2.6 (0.6–4.4) | 0.008 |
Abscess | 59/26 (69) | 3.57 (2.67–4.69) | < 0.001 | 5.3 (3.2–7.5) | < 0.001 |
Wound infection | 58/35 (62) | 2.96 (2.20–3.89) | < 0.001 | 4.6 (2.8–6.9) | < 0.001 |
Urological complication | 31/49 (39) | 1.59 (1.08–2.26) | 0.003 | 1.3 (− 0.3–2.9) | 0.121 |
Thromboembolic complication | 17/15 (53) | 2.63 (1.54–4.17) | < 0.001 | 0.8 (− 0.2–1.8) | 0.145 |
Chyle leakage | 17/21 (45) | 2.16 (1.27–3.42) | < 0.001 | 1.6 (0.4–2.8) | 0.006 |
Postoperative bleeding | 19/16 (54) | 2.29 (1.39–3.53) | < 0.001 | 1.4 (0.2–2.6) | 0.015 |
Bowel injury | 18/8 (69) | 2.98 (1.78–4.68) | < 0.001 | 1.2 (0.0–2.3) | 0.052 |
Postoperative complication | No. with/without re-intervention (% re-intervention) | Risk-adjusted associationa | Risk-adjusted PAFb | ||
---|---|---|---|---|---|
Adjusted relative risk (95% CI) | p value | PAF% (95% CI) | p value | ||
Pulmonary complication | 119/202 (37) | 2.72 (2.15–3.42) | < 0.001 | 11.3 (7.2–15.5) | < 0.001 |
Anastomotic leakage | 129/25 (84) | 7.25 (5.70–9.21) | < 0.001 | 25.1 (20.5–29.7) | < 0.001 |
Cardiac complication | 46/76 (38) | 2.36 (1.69–3.23) | < 0.001 | 1.6 (– 0.8–4.0) | 0.206 |
Acute delirium | 37/66 (36) | 2.29 (1.58–3.21) | < 0.001 | 1.7 (– 0.6–3.9) | 0.153 |
Abscess | 72/13 (85) | 6.22 (4.73–8.12) | < 0.001 | 11.5 (8.2–14.8) | < 0.001 |
Wound infection | 57/36 (61) | 4.28 (3.15–5.73) | < 0.001 | 6.9 (4.4–9.9) | < 0.001 |
Urological complication | 20/60 (25) | 1.50 (0.92–2.32) | 0.050 | – | – |
Thromboembolic complication | 13/19 (41) | 2.61 (1.41–4.40) | < 0.001 | 0.2 (– 0.6–0.9) | 0.674 |
Chyle leakage | 13/25 (34) | 2.28 (1.23–3.83) | < 0.001 | 1.5 (0.2–2.9) | 0.029 |
Post–operative bleeding | 26/9 (74) | 4.60 (2.99–6.79) | < 0.001 | 4.1 (2.0–6.3) | < 0.001 |
Bowel injury | 25/1 (96) | 6.02 (3.85–9.01) | < 0.001 | 3.6 (1.8–5.5) | < 0.001 |
Postoperative complication | No. with/without reoperation (% reoperation) | Risk-adjusted associationa | Risk-adjusted PAFb | ||
---|---|---|---|---|---|
Adjusted relative risk (95% CI) | p value | PAF% (95% CI) | p value | ||
Pulmonary complication | 85/236 (27) | 2.62 (1.98–3.43) | < 0.001 | 10.3 (4.8–15.9) | < 0.001 |
Anastomotic leakage | 102/52 (66) | 8.56 (6.46–11.3) | < 0.001 | 30.3 (24.3–36.3) | < 0.001 |
Cardiac complication | 33/89 (27) | 2.37 (1.59–3.42) | < 0.001 | 2.2 (– 0.1–5.7) | 0.224 |
Acute delirium | 24/79 (23) | 2.04 (1.29–3.08) | < 0.001 | 0.4 (– 2.6–3.5) | 0.787 |
Abscess | 41/44 (48) | 4.75 (3.32–6.66) | 0.003 | 5.9 (2.5–9.4) | < 0.001 |
Wound infection | 49/44 (53) | 5.13 (3.64–7.11) | < 0.001 | 10.6 (6.5–14.8) | < 0.001 |
Urological complication | 15/65 (19) | 1.60 (0.90–2.63) | 0.067 | – | – |
Thromboembolic complication | 12/20 (38) | 3.68 (1.93–6.38) | < 0.001 | 1.5 (0.5–3.0) | 0.042 |
Chyle leakage | 6/32 (16) | 1.48 (0.58–3.06) | 0.318 | – | – |
Postoperative bleeding | 24/11 (69) | 5.52 (3.49–8.33) | < 0.001 | 5.7 (2.9–8.5) | < 0.001 |
Bowel injury | 24/2 (92) | 8.03 (5.03–12.30) | < 0.001 | 5.8 (3.1–8.6) | < 0.001 |
Postoperative complication | No. with/without readmission (% readmission) | Risk-adjusted associationa | Risk-adjusted PAFb | ||
---|---|---|---|---|---|
Adjusted relative risk (95% CI) | p value | PAF% (95% CI) | p value | ||
Pulmonary complication | 53/268 (17) | 1.39 (1.01–1.88) | 0.026 | 3.0 (– 2.9–8.9) | 0.315 |
Anastomotic leakage | 32/122 (21) | 1.68 (1.12–2.43) | 0.005 | 2.3 (– 2.2–6.7) | 0.319 |
Cardiac complication | 19/103 (16) | 1.20 (0.72–1.89) | 0.405 | – | – |
Acute delirium | 20/83 (19) | 1.52 (0.92–2.37) | 0.044 | 1.1 (– 2.1–4.3) | 0.508 |
Abscess | 31/54 (37) | 3.24 (2.16–4.70) | < 0.001 | 7.0 (3.2–10.9) | < 0.001 |
Wound infection | 27/66 (29) | 2.70 (1.75–3.99) | < 0.001 | 5.1 (1.5–8.8) | 0.006 |
Urological complication | 10/70 (13) | 0.97 (0.48–1.74) | 0.912 | – | – |
Thromboembolic complication | 6/26 (19) | 1.45 (0.57–3.01) | 0.300 | – | – |
Chyle leakage | 5/33 (13) | 1.14 (0.40–2.49) | 0.762 | – | – |
Postoperative bleeding | 9/26 (26) | 2.15 (1.02–3.97) | 0.010 | 1.4 (– 0.6–3.5) | 0.172 |
Bowel injury | 9/17 (35) | 2.93 (1.38–5.45) | < 0.001 | 1.4 (– 0.6–3.4) | 0.164 |