J. Maxwell Chamberlain memorial paper
Outcomes after esophagectomy: a ten-year prospective cohort

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
https://doi.org/10.1016/S0003-4975(02)04368-0Get rights and content

Abstract

Background

The Department of Veterans Affairs National Surgical Quality Improvement Program is a unique resource to prospectively analyze surgical outcomes from a cross-section of surgical services nationally. We used this database to assess risk factors for morbidity and mortality after esophagectomy in Veterans Affairs Medical Centers from 1991 to 2001.

Methods

A total of 1,777 patients underwent an esophagectomy at 109 Veterans Affairs hospitals with complete in-hospital and 30-day outcomes recorded. Bivariate and multivariable analyses were completed.

Results

Thirty-day mortality was 9.8% (174/1,777) and the incidence of one or more of 20 predefined complications was 49.5% (880/1,777). The most frequent postoperative complications were pneumonia in 21% (380/1,777), respiratory failure in 16% (288/1,777), and ventilator support more than 48 hours in 22% (387/1,777). Preoperative predictors of mortality based on multivariable analysis included neoadjuvant therapy, blood urea nitrogen level of more than 40 mg/dL, alkaline phosphatase level of more than 125 U/L, diabetes mellitus, alcohol abuse, decreased functional status, ascites, and increasing age. Preoperative factors impacting morbidity were increasing age, dyspnea, diabetes mellitus, chronic obstructive pulmonary disease, alkaline phosphatase level of more than 125 U/L, lower serum albumin concentration, increased complexity score, and decreased functional status. Intraoperative risk factors for mortality included the need for transfusion; intraoperative risk factors for morbidity included the need for transfusion and longer operative time.

Conclusions

These data constitute the largest prospective outcomes cohort in the literature and document a near 50% morbidity rate and 10% mortality rate after esophagectomy. Data from this study can be used to better stratify patients before esophagectomy.

Section snippets

Patients and methods

The methods of the VA NSQIP have been described in detail elsewhere 9, 10, 11.

Patient characteristics and outcomes

The study population consisted of 1,777 patients who underwent esophagectomy. The sample was predominantly male (99.1%, n = 1,761) with a mean age of 63.4 ± 9.9 years. Esophageal resection was performed for a neoplastic process in 84.9% (n = 1509) and for benign disease in 15.1% (n = 269). Other patient characteristics are listed in Table 1. Thirty-day mortality was 9.8% (n = 174) and morbidity was 49.5% (n = 880). No difference was noted in 30-day mortality when comparing patients with benign

Comment

In this study, we analyzed the factors affecting perioperative morbidity and mortality in 1,777 patients undergoing esophagectomy in 109 VA Medical Centers during a 10-year period. This report represents the largest prospective study of perioperative outcomes after esophagectomy. The VA NSQIP offers a unique opportunity to study perioperative outcomes because of the large number of patients enrolled and the reliable prospective collection of data by trained and audited nurses.

Our analysis

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