title: Comorbidities and Risk of Complications After Surgery for Esophageal Cancer: A Nationwide Cohort Study in Sweden.
abstract: BACKGROUND
  The selection for surgery is multifaceted for patients diagnosed with esophageal cancer. Since it is uncertain how comorbidity should influence the selection, this study addressed comorbidities in relation to risk of severe complications following esophageal cancer surgery.
  
  
  METHODS
  This population-based cohort study was based on prospectively included patients who underwent surgical resection for an esophageal or gastro-esophageal junctional cancer in Sweden during 2001-2005. The participation rate was 90%. Associations between pre-defined comorbidities and pre-defined post-operative complications occurring within 30 days of surgery were analyzed using multivariable logistic regression. The resulting odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, sex, tumor stage, tumor histology, neoadjuvant therapy, type of surgery, annual hospital volume, other comorbidities, and other complications.
  
  
  RESULTS
  Among 609 included patients, those with cardiac disease (n = 92) experienced an increased risk of pre-defined complications in general (adjusted OR 1.81, 95% CI 1.13-2.90), while patients with hypertension (n = 137), pulmonary disorders (n = 79), diabetes (n = 67), and obesity (n = 66) did not. Patients with a Charlson comorbidity index score ≥2 had substantially increased risks of pre-defined complications (adjusted OR 2.44, 95% CI 1.60-3.72).
  
  
  CONCLUSIONS
  Cardiac disease and a Charlson comorbidity index score ≥2 seem to increase the risk of severe and early post-operative complications in patients with esophageal cancer, while hypertension, pulmonary disorders, diabetes, and obesity do not. These findings should be considered in the clinical decision-making for improved selection of patients for surgery.
authors.affiliation: Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, NS 67, 2nd Floor, 17176, Stockholm, Sweden, lovisa.backemar@ki.se.
authors.forename: Lovisa
authors.initials: L
authors.lastname: Backemar
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
authors.forename: Therese
authors.initials: T
authors.lastname: Djärv
authors.forename: Asif
authors.initials: A
authors.lastname: Johar
authors.forename: Anna
authors.initials: A
authors.lastname: Wikman
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology