TY - JOUR
T1 - Patient and Peri-operative Predictors of Morbidity and Mortality After Esophagectomy
T2 - American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2008
AU - Dhungel, Birat
AU - Diggs, Brian S.
AU - Hunter, John G.
AU - Sheppard, Brett C.
AU - Vetto, John T.
AU - Dolan, James P.
PY - 2010
Y1 - 2010
N2 - Purpose: Our aim was to determine what specific patient and peri-operative factors contribute to major complications after esophagectomy. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program database, data for esophagectomies between the years 2005 and 2008 were extracted and analyzed. Thirty-day post-operative complications were classified into seven major groups: (1) wound infections, (2) respiratory complications (pneumonia, intubation), (3) cardiac complications, (4) deep venous thrombosis, (5) sepsis/septic shock, (6) re-operation, and (7) death. Univariate analysis and logistic regression modeling were performed to determine if a significant association existed between patient factors or peri-operative factors and these post-operative complications. Results: One thousand thirty-two patients who underwent esophagectomy were identified. Diabetes was the strongest pre-operative independent predictor of death (odds ratio (OR) 10.98; 95% confidence interval (CI) 1.37-1.15, p < 0.1) or respiratory (OR 1.86; 95% CI 1.03-3.29, p = 0.04) or cardiac (OR 5.14; 95% CI 1.93-13.20, p < 0.01) complications following esophagectomy. Thoracotomy performed during the operation was not associated with an increased risk of respiratory or cardiac complications. Conclusions: The major predictors of morbidity after an esophagectomy are the patient factors of diabetes, dyspnea, peripheral vascular disease, and cerebrovascular accident while the peri-operative factors are pre-operative international normalized ratio, contaminated wound classification, and American Society of Anesthesiologists class. Similarly, the major predictors of mortality are diabetes, dyspnea, and age for patient factors and contaminated wound classification for peri-operative factors.
AB - Purpose: Our aim was to determine what specific patient and peri-operative factors contribute to major complications after esophagectomy. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program database, data for esophagectomies between the years 2005 and 2008 were extracted and analyzed. Thirty-day post-operative complications were classified into seven major groups: (1) wound infections, (2) respiratory complications (pneumonia, intubation), (3) cardiac complications, (4) deep venous thrombosis, (5) sepsis/septic shock, (6) re-operation, and (7) death. Univariate analysis and logistic regression modeling were performed to determine if a significant association existed between patient factors or peri-operative factors and these post-operative complications. Results: One thousand thirty-two patients who underwent esophagectomy were identified. Diabetes was the strongest pre-operative independent predictor of death (odds ratio (OR) 10.98; 95% confidence interval (CI) 1.37-1.15, p < 0.1) or respiratory (OR 1.86; 95% CI 1.03-3.29, p = 0.04) or cardiac (OR 5.14; 95% CI 1.93-13.20, p < 0.01) complications following esophagectomy. Thoracotomy performed during the operation was not associated with an increased risk of respiratory or cardiac complications. Conclusions: The major predictors of morbidity after an esophagectomy are the patient factors of diabetes, dyspnea, peripheral vascular disease, and cerebrovascular accident while the peri-operative factors are pre-operative international normalized ratio, contaminated wound classification, and American Society of Anesthesiologists class. Similarly, the major predictors of mortality are diabetes, dyspnea, and age for patient factors and contaminated wound classification for peri-operative factors.
KW - ACS-NSQIP
KW - Esophageal morbidity
KW - Esophageal mortality
KW - Esophagectomy
KW - Peri-operative factors
UR - http://www.scopus.com/inward/record.url?scp=77957018617&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77957018617&partnerID=8YFLogxK
U2 - 10.1007/s11605-010-1328-2
DO - 10.1007/s11605-010-1328-2
M3 - Article
C2 - 20824375
AN - SCOPUS:77957018617
SN - 1091-255X
VL - 14
SP - 1492
EP - 1501
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 10
ER -