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Ann Thorac Surg 2003;75:217-222
© 2003 The Society of Thoracic Surgeons

J. Maxwell Chamberlain Memorial Paper

Outcomes after esophagectomy: a ten-year prospective cohort

Stephen H. Bailey, MDa, David A. Bull, MDa*, David H. Harpole, MDb, Jeffrey J. Rentz, MDa, Leigh A. Neumayer, MDa, Theodore N. Pappas, MDb, Jennifer Daley, MDc,d,e, William G. Henderson, PhDd,e, Barbara Krasnicka, PhDe, Shukri F. Khuri, MDc,d,e

a Veterans Affairs Medical Center, University of Utah Medical School, Salt Lake City, Utah, USA
b Veterans Affairs Medical Center, Duke University Medical School, Durham, North Carolina, USA
c Institute for Health Policy, Massachusetts General Hospital/Partners Healthcare System and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
d Veterans Affairs Medical Center, Harvard Medical School, Brockton/West Roxbury, Massachusetts, USA
e Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Hines, Illinois, USA

* Address reprint requests to Dr Bull, 50 North Medical Drive, University of Utah, Division of Cardiothoracic Surgery, Room 3C127, Salt Lake City, UT 84132, USA
e-mail: david.bull{at}hsc.utah.edu

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

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.




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