Mortality After Esophagectomy: Analysis of Individual Complications and Their Association with Mortality

  • Philip A. Linden
  • Christopher W. Towe
  • Thomas J. Watson
  • Donald E. Low
  • Stephen D. Cassivi
  • Maria Grau-Sepulveda
  • Stephanie G. Worrell
  • Yaron PerryEmail author
Original Article



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.


Esophagectomy Morbidity Mortality Outcomes 



atrial fibrillation


adult respiratory distress syndrome


coronary artery disease


chronic obstructive lung disease


diabetes mellitus


deep venous thrombosis


general thoracic surgery database


odds ratio


myocardial infarction


pulmonary embolus


Society of Thoracic Surgery


Authors’ Contributions

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.

Funding Information

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.


  1. 1.
    Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high risk surgery. N Engl J Med 2011;364:2128–2137.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Markar S, Gronnier C, Duhamel A, Bigourdan JM, Badic B, du Rieu MC, Lefevre JH, Turner K, Luc G, Mariette C. Pattern of postoperative mortality after esophageal cancer resection according to center volume results from a large European multicenter study. Ann Surg Oncol 2015;22:2615–2623CrossRefPubMedGoogle Scholar
  3. 3.
    LaPar DJ, Stukenborg GJ, Lau CL, Jones DR, Kozower BD. Differences in reported esophageal cancer resection outcomes between national clinical and administrative databases. J Thorac Cardiovasc Surg 2012;144:1152–1159.CrossRefPubMedGoogle Scholar
  4. 4.
    Schieman C, Wigle DA, Deschamps F, Nichols FC, Cassivi SD, Shen R, Allen MS. Patterns of operative mortality following esophagectomy. Dis Esoph 2012:25:645–651.CrossRefGoogle Scholar
  5. 5.
    Martin LW, Swisher SG, Hofstetter W, Correa AM, Mehran RJ, Rice DC, Vaporciyan AA, Walsh GL, Roth, JA. Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg 2005;242:392–402.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Sarela AI, Tolan DJ, Harris K, Dexter SP, Sue-Ling HM. Anastomotic leakage after esophagectomy for cancer: a mortality-free experience. J Am Coll Surg 2008;206:516–523CrossRefPubMedGoogle Scholar
  7. 7.
    Wright CD, Kurcharczuk JC, O’Brien SM, Grab JD, Allen MS. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgeons Database risk adjustment model. J Thorac Cardiovasc Surg 2009;137:587–596.CrossRefPubMedGoogle Scholar
  8. 8.
    Raymond DP, Seder CW, Wright CD, Magee MJ, Kosinski AS, Cassivi SD et al. Predictors of major morbidity or mortality after resection for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. Ann Thorac Surg 2016;102:207–214CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and failure to rescue with high-risk surgery. Med Care 2011;49:1076–1081.CrossRefGoogle Scholar
  10. 10.
    Badhwar V, Rankin JS, Jacobs JP, Shahian DM, Habib RH, D'Agostino RS, Thourani VH, Suri RM, Prager RL, Edwards FH. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 update on research. Ann Thorac Surg. 2016 Jul;102(1):7–13.CrossRefPubMedGoogle Scholar
  11. 11.
    Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications. Ann Surg 2004;240(2):205–213.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Goense L, Meziani J, Ruurda JP and van Hillegersberg R. Impact of postoperative complications on outcomes after oesophagectomy for cancer, BJS 2019; 106: 111–119CrossRefGoogle Scholar
  13. 13.
    Murthy SC, Law S, Whooley BP, Alexandrou A, Chu KM, Wong J. Atrial fibrillation after esophagectomy is a marker for postoperative morbidity and mortality. J Thorac Cardiovasc Surg 2003.Google Scholar
  14. 14.
    Mccormack O, Zaborowski A, King S, Healy L, Daly C, O’Farrell N, Donohoe CL, Ravi N, Reynolds JV. New-onset atrial fibrillation post-surgery for esophageal and junctional cancer. Ann Surg 2014; 260:772–778.CrossRefGoogle Scholar
  15. 15.
    Tisdale JE, Wroblewski HA, Wall DS, Rieger KM, Hammoud ZT, Young JV, Kesler KA. A randomized, controlled study of amiodarone for prevention of atrial fibrillation after transthoracic esophagectomy. J Thorac Cardiovasc Surg 2010;140:45–51.CrossRefPubMedGoogle Scholar
  16. 16.
    Reames BN, Ghaferi AA, Birkmeher, Dimick JB. Hospital volume and operative mortality in the modern era. Ann Surg. 2014:260;244–251.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Funk M, Gawande A, Semel ME, Lipsitz SR, Berry WR, Zinner MJ, Jha AK Esophagectomy outcomes at low-volume hospitals, the association between systems characteristics and mortality. Ann Surg 2011;253:912–917.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.University Hospitals Cleveland Medical Center and Case Western Reserve School of MedicineClevelandUSA
  2. 2.MedStar Washington Hospital CenterWashingtonUSA
  3. 3.Virginia Mason Medical CenterSeattleUSA
  4. 4.Mayo ClinicRochesterUSA
  5. 5.Duke Clinical Research UnitDurhamUSA

Personalised recommendations