title: Factors Affecting Hospital Mortality in Patients with Esophagogastric Anastomotic Leak: A Retrospective Study.
abstract: OBJECTIVE
  We aimed to clarify the association between anastomotic leak and leak-associated mortality to assist decision-making and reduce hospital mortality.
  
  
  BACKGROUND
  Anastomotic leak is a common complication after esophagectomy, but the nature of its relationship to leak-associated mortality has not been established.
  
  
  METHODS
  A retrospective review of all esophagogastric anastomotic leaks that had occurred between 2008 and 2012 at our institution (n = 246) was performed. Risk factors for leak-associated mortality were determined using a multivariate logistic regression analysis.
  
  
  RESULTS
  Of the 246 patients with anastomotic leaks, 14 (5.7 %) died. Leak-associated mortality rates were similar regardless of anastomosis location (cervical vs. thoracic anastomosis), surgical approaches (retrosternal vs. prevertebral reconstruction route) and anastomotic techniques (hand-sewn vs. mechanical anastomosis). When a leak occurred, risk factors for leak-associated mortality as determined by multivariate logistic analysis included patient age >60 years (P = 0.029) and the occurrence of the leak within 1 week of surgery (P = 0.039). When disease worsened after treatment, leak-associated mortality was more frequent in patients requiring reintubation (25.6 vs. 1.4 %, P < 0.001). Fatal bleeding and sepsis were the most common causes of leak-associated mortality.
  
  
  CONCLUSIONS
  In patients with anastomotic leaks, patient age >60 years and the occurrence of the leak within 1 week of surgery were risk factors for leak-associated mortality. Increased efforts to reduce the incidence of early anastomotic leaks within 1 week after surgery and prevent the need for reintubation are important for improving patient prognosis.
authors.affiliation: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China.
authors.forename: Jiaqing
authors.initials: J
authors.lastname: Xiang
authors.affiliation: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China.
authors.forename: Yawei
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China.
authors.forename: Yihua
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. hqchen1@yahoo.com.|Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China. hqchen1@yahoo.com.
authors.forename: Haiquan
authors.initials: H
authors.lastname: Chen
mesh_terms: D000367:Age Factors; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000401:mortality*; D002681:China / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors