Textbook outcomes after esophagectomy: A five-year of experience at a specialized centre in a developing country.

Abstract

e16160 Background: A textbook outcome is a distinct measure that promotes better short- and long-term patient outcomes, improves the quality of care at individual centres, reduces costs, and helps standardize care across the healthcare system. Achieving this outcome has been associated with long-term advantages, including higher rates of disease-free survival and overall survival. A textbook outcome was achieved when all the criteria met, it is all or none response. Methods: Retrospective analysis of prospectively collected data from 1st January 2019 to 31st December 2023 . INCLUSION CRITERIA Patients who underwent esophagectomies for oesophageal cancer. EXCLUSION CRITERIA: Patients with missing data necessary for the definition of textbook outcome were excluded. Results: Total number of patients were 569 in 5 years out of which 51% were female. Mean age was 45±9.8 years, mean BMI 21.7±4kg/m2 and ASA of 2. Mean albumin was 4g/dl. Most common site of disease was Distal Oesophagus which was in 59.6%, commonest pathology was Squamous cell carcinoma 85%. Most common procedure performed was Three stage esophagectomy (McKeown) in78% patients, and 97% of procedures were performed laparoscopically. Total of 9 textbook outcomes were assessed. Highest achieved outcomes were No readmission in ICU, and No In house mortality, which were 97% and 96.7%, respectively. Following that, no readmission in 30 days, no anastomotic leak, no intraoperative complications, and Clavien Dindo class < 3 complications, were achieved in 94.4%, 94.2%, 94.9% and 94.4%, respectively. Margin negative was achieved in 95.3%, ≤14 days admission in 90.3%. The least achieved outcome was lymph node retrieval (≥ 15 lymph nodes), which was achieved in 58.3% of patients. Overall textbook outcomes achieved in 43.1% patients. Recurrence was observed in 25% of patients, out of which 65% were those who did not achieved textbook outcome. Overall survival in patients who met textbook outcomes was 30±16 months compared to 27±17 months in those who did not achieve textbook outcomes. Conclusions: We used the textbook outcome composite measure to evaluate our hospital performance, our institution has achieved exceptionally good textbook outcomes and are comparable with international centres.