Mortality After Esophagectomy: Analysis of Individual Complications and Their Association with Mortality
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The relationship between individual complications and esophagectomy mortality is unclear. The influence of comorbidities on the impact of complications on operative mortality is also unknown. We sought to assess the impact of individual complications and the effect of coexisting comorbidities on operative mortality following esophagectomy.
All gastric conduit esophagectomies performed for cancer from 2008 to 2017 in the Society of Thoracic Surgery database were identified. Chi square was utilized to identify postoperative events associated with operative mortality. Multivariable logistic regression analysis was performed, utilizing postoperative events, to determine the risk-adjusted effect on operative mortality for each postoperative event. To assess the effect of preoperative comorbidities, a second logistic regression analysis was performed, incorporating preoperative characteristics.
Of 11,943 esophagectomy patients, 63.9% had a postoperative event and 3.3% died, which did not change over the study period. The postoperative events with the highest impact on operative mortality were respiratory distress syndrome (OR 7.48 (95% CI 5.23–10.7)), reintubation (OR 6.55 (4.61–9.30)), and renal failure (OR 5.97 (4.08–8.75)). Anastomotic leak requiring reoperation was associated with increased operative mortality (OR 1.48 (1.03–2.14)), but medically managed leak was not. Incorporating preoperative characteristics into the operative mortality model had little effect on odds ratio for death for individual postoperative events.
In the Society of Thoracic Surgery database, 64% of patients suffer postoperative events and 3.3% die following esophagectomy. The independent association of certain postoperative events with mortality is an objective method of terming a complication “major” and may aid efforts to reduce mortality.
KeywordsEsophagectomy Morbidity Mortality Outcomes
adult respiratory distress syndrome
coronary artery disease
chronic obstructive lung disease
deep venous thrombosis
general thoracic surgery database
Society of Thoracic Surgery
Each of the authors has either made substantial contributions to the conception or design of the study or the acquisition, analysis, or interpretation of data for the work; contributed to drafting the work or revising for important intellectual content; will give final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
This work is funded by the Society of Thoracic Surgery.
Compliance with Ethical Standards
Conflict of Interest
CWT is a consultant for Atricure, Medtronic, Zimmer Biomet, and SigMedical. No other authors declare conflicts of interest.
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