Outcomes after esophagectomy: a ten-year prospective cohort.
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.
Bailey
Stephen H
SH
Veterans Affairs Medical Center, University of Utah Medical School, Salt Lake City, Utah 84132, USA.
Bull
David A
DA
Harpole
David H
DH
Rentz
Jeffrey J
JJ
Neumayer
Leigh A
LA
Pappas
Theodore N
TN
Daley
Jennifer
J
Henderson
William G
WG
Krasnicka
Barbara
B
Khuri
Shukri F
SF
D000367:Age Factors; D000437:Alcoholism / Q000150:complications; D000469:Alkaline Phosphatase / Q000097:blood; D001201:Ascites / Q000150:complications; D001806:Blood Urea Nitrogen; D015331:Cohort Studies; D048909:Diabetes Complications; D004417:Dyspnea / Q000150:complications; D016629:Esophagectomy / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012131:Respiratory Insufficiency / Q000209:etiology; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D016896:Treatment Outcome
D012709:Serum Albumin; D000469:Alkaline Phosphatase