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| Predictors of Major Morbidity and Mortality after Esophagectomy for Esophageal Cancer: An STS General Thoracic Surgery Database Risk Adjustment Model | ||||||||||||||||||||||||||||||||
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Cameron D. Wright1, Mark S. Allen2, Joshua D. Grab3, John C. Kucharczuk4; 1Massachusetts General Hospital, Boston, MA; 2Mayo Clinic, Rochester, MN; 3Duke Clinical Research Institute, Durham, NC; 4University of Pennsylvania, Philadelphia, PA Objective: The prediction of perioperative risk in esophagectomy for esophageal cancer is unreliable. We sought to create a model adjusted for preoperative risk factors using the STS General Thoracic Database (STS GTDB). Methods: The STS GTDB was queried for all patients treated with esophagectomy for esophageal cancer for the time period from January 2002 to June 2006. A multivariable risk model for mortality and major morbidity was constructed and confirmed with a bootstrap analysis. Results: There were 1393 esophagectomies performed by 50 participating centers. Patients older than 75 constituted 17% (293/1393) of the cohort. The hospital mortality was 2.4% (33/1393). Major morbidity (defined as reoperation for bleeding (n=5), anastomotic leak (n=143), pneumonia (n=97), reintubation (n=108), ventilation beyond 48 hours (n=37) or death (n=33)) occurred in 20.6% (287/1393) of patients. The mean length of stay was 14 days for the entire cohort (median 9 days) and 27 days for patients with major morbidity. Induction therapy was administered in 42% (590/1393) of patients and was not associated with increased morbidity or mortality. Preoperative spirometry was obtained in 36% (507/1393) of patients. A FEV1<60% of predicted was associated with major morbidity (OR 1.80, p=0.002). The multivariate predictors of major morbidity are seen in the Table. Conclusion: Thoracic surgeons participating in the STS GTDB perform esophagectomy with a low mortality. Age, race, medical co-morbidities, smoking status and significant obstructive lung disease are predictors of major morbidity and mortality after esophagectomy for esophageal cancer. Prognostic factors identified in this analysis may help to predict risk in individual patients and guide quality improvement by risk-adjusted feedback. Predictors of Major Morbidity after Esophagectomy
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