title: Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2008.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of General Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L223A, Portland, OR 97239, USA.
authors.forename: Birat
authors.initials: B
authors.lastname: Dhungel
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.forename: John G
authors.initials: JG
authors.lastname: Hunter
authors.forename: Brett C
authors.initials: BC
authors.lastname: Sheppard
authors.forename: John T
authors.initials: JT
authors.lastname: Vetto
authors.forename: James P
authors.initials: JP
authors.lastname: Dolan
mesh_terms: D016208:Databases, Factual; D004935:Esophageal Diseases / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D013272:Stomach Diseases / Q000601:surgery*
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