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Factors Affecting Hospital Mortality in Patients with Esophagogastric Anastomotic Leak: A Retrospective Study

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Abstract

Objective

We aimed to clarify the association between anastomotic leak and leak-associated mortality to assist decision-making and reduce hospital mortality.

Background

Anastomotic leak is a common complication after esophagectomy, but the nature of its relationship to leak-associated mortality has not been established.

Methods

A retrospective review of all esophagogastric anastomotic leaks that had occurred between 2008 and 2012 at our institution (n = 246) was performed. Risk factors for leak-associated mortality were determined using a multivariate logistic regression analysis.

Results

Of the 246 patients with anastomotic leaks, 14 (5.7 %) died. Leak-associated mortality rates were similar regardless of anastomosis location (cervical vs. thoracic anastomosis), surgical approaches (retrosternal vs. prevertebral reconstruction route) and anastomotic techniques (hand-sewn vs. mechanical anastomosis). When a leak occurred, risk factors for leak-associated mortality as determined by multivariate logistic analysis included patient age >60 years (P = 0.029) and the occurrence of the leak within 1 week of surgery (P = 0.039). When disease worsened after treatment, leak-associated mortality was more frequent in patients requiring reintubation (25.6 vs. 1.4 %, P < 0.001). Fatal bleeding and sepsis were the most common causes of leak-associated mortality.

Conclusion

In patients with anastomotic leaks, patient age >60 years and the occurrence of the leak within 1 week of surgery were risk factors for leak-associated mortality. Increased efforts to reduce the incidence of early anastomotic leaks within 1 week after surgery and prevent the need for reintubation are important for improving patient prognosis.

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Acknowledgments

We thank Huixun Jia (Department of biostatistics, Fudan University Shanghai Cancer Center) for her contribution to the statistical analysis in this article.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

    Bin Li, Jiaqing Xiang, Yawei Zhang, Hong Hu, Yihua Sun & Haiquan Chen

  2. Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong’an Rd, Shanghai, 20032, China

    Bin Li, Jiaqing Xiang, Yawei Zhang, Hong Hu, Yihua Sun & Haiquan Chen

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  1. Bin Li
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  2. Jiaqing Xiang
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  3. Yawei Zhang
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  4. Hong Hu
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Correspondence to Haiquan Chen.

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The authors declaim no grant support for the research reported and no conflict of interest.

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Li, B., Xiang, J., Zhang, Y. et al. Factors Affecting Hospital Mortality in Patients with Esophagogastric Anastomotic Leak: A Retrospective Study. World J Surg 40, 1152–1157 (2016). https://doi.org/10.1007/s00268-015-3372-2

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  • DOI: https://doi.org/10.1007/s00268-015-3372-2

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