title: In-hospital mortality after a surgical resection for esophageal cancer: analyses of the associated factors and historical changes.
abstract: BACKGROUND
  Resections for esophageal cancer are invasive, with high mortality and morbidity rates. The object of this study was to clarify the factors associated with in-hospital death while also evaluating any associated historical changes in the characteristics of such deaths.
  
  
  METHODS
  The factors associated with mortality were examined by logistic regression analysis in 1106 patients who underwent an esophagectomy for esophageal cancer. The historical changes in the characteristics of in-hospital deaths were also evaluated.
  
  
  RESULTS
  A multivariate analysis revealed that not only undergoing an esophagectomy before 1979, but also a patient's age (odds ratio 1.070 for every increase in age by year) and an incomplete resection (odds ratio 2.265) were independent factors associated with in-hospital death. The in-hospital mortality rates were 16.1%, 5.8%, 2.5%, and 3.1%, while the 30-day mortality rates were 9.2%, 2.2%, 0.8%, and 0.3% during 1964-1979, the 1980s, the 1990s, and the 2000s, respectively. Eight patients had preoperative comorbidities among 11 patients who died in the hospital after 1997. The mortality rate was 5.5% in patients with any comorbidities, while it was 1.3% in patients without any comorbidities (P = 0.026). The most common direct cause of in-hospital death was previous pulmonary complications; however, cancer progression has recently become the most common cause.
  
  
  CONCLUSIONS
  To prevent in-hospital mortality after an esophagectomy, strict indications for surgery and careful perioperative management are important, especially in high-risk patients with advanced esophageal cancer.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. masarum@surg2.med.kyushu-u.ac.jp
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Tomonori
authors.initials: T
authors.lastname: Nakanoko
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Fujinaka
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Kubo
authors.forename: Natsumi
authors.initials: N
authors.lastname: Yamashita
authors.forename: Keiji
authors.initials: K
authors.lastname: Yoshinaga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Emi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome