Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database.
BACKGROUND
Anastomotic leak is an important cause of morbidity and mortality after esophagectomy. Few studies have targeted risk factors for the development of leak after esophagectomy. The purpose of this study is to use The Society of Thoracic Surgeons Database to identify variables associated with leak after esophagectomy.


METHODS
The Society of Thoracic Surgeons Database was queried for patients treated with esophagectomy for esophageal cancer between 2001 and 2011. Univariate and multivariate analysis of variables associated with an increased risk anastomotic leak was performed.


RESULTS
There were 7,595 esophagectomies, with 804 (10.6%) leaks. Thirty-day mortality and length of stay were higher for patients with anastomotic leak. Mortality in patients requiring surgical management was 11.6% (38 of 327) compared with 4.4% (20 of 458) in medically managed leaks (p < 0.001). The leak rate was higher in patients with cervical anastomosis compared with those with intrathoracic anastomoses, 12.3% versus 9.3%, respectively (p = 0.006). There was no difference in leak-associated mortality between the two approaches. Factors associated with leak on univariate analysis include obesity, heart failure, coronary disease, vascular disease, hypertension, steroids, diabetes, renal insufficiency, tobacco use, procedure duration greater than 5 hours, and type of procedure (p < 0.05). Multivariable regression analysis associated heart failure, hypertension, renal insufficiency, and type of procedure as risk factors for the development of leak (p < 0.05).


CONCLUSIONS
Anastomotic leak after esophagectomy is an important cause of postoperative mortality and increased length of stay. We have identified important risk factors for the development of esophageal anastomotic leak after esophagectomy. Further studies aimed at risk reduction are warranted.
Division of Thoracic Surgery, The Ohio State University Medical Center, Columbus, Ohio. Electronic address: edmund.kassis@osumc.edu.
Edmund S
ES
Kassis
Andrzej S
AS
Kosinski
Patrick
P
Ross
Katherine E
KE
Koppes
James M
JM
Donahue
Vincent C
VC
Daniel
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009820:Ohio / Q000453:epidemiology; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical / Q000706:statistics & numerical data*; D013270:Stomach / Q000601:surgery*; D015996:Survival Rate / Q000639:trends
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