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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

AF:

atrial fibrillation

ARDS:

adult respiratory distress syndrome

CAD:

coronary artery disease

COPD:

chronic obstructive lung disease

DM:

diabetes mellitus

DVT:

deep venous thrombosis

GTSD:

general thoracic surgery database

OR:

odds ratio

MI:

myocardial infarction

PE:

pulmonary embolus

STS:

Society of Thoracic Surgery

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Funding

This work is funded by the Society of Thoracic Surgery.

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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.

Corresponding author

Correspondence to Yaron Perry.

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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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Linden, P.A., Towe, C.W., Watson, T.J. et al. Mortality After Esophagectomy: Analysis of Individual Complications and Their Association with Mortality. J Gastrointest Surg 24, 1948–1954 (2020). https://doi.org/10.1007/s11605-019-04346-2

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Keywords

  • Esophagectomy
  • Morbidity
  • Mortality
  • Outcomes