Post-discharge complications after esophagectomy account for high readmission rates.
OBJECTIVE
To identify rates of post-discharge complications (PDC), associated risk factors, and their influence on early hospital outcomes after esophagectomy.


METHODS
We used the 2005-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify patients ≥ 18 years of age who underwent an esophagectomy. These procedures were categorized into four operative approaches: transhiatal, Ivor-Lewis, 3-holes, and non-gastric conduit. We selected patient data based on clinical relevance to patients undergoing esophagectomy and compared demographic and clinical characteristics. The primary outcome was PDC, and secondary outcomes were hospital readmission and reoperation. The patients were then divided in 3 groups: no complication (Group 1), only pre-discharge complication (Group 2), and PDC patients (Group 3). A modified Poisson regression analysis was used to identify risk factors associated with developing post-discharge complication, and risk ratios were estimated.


RESULTS
4483 total patients were identified, with 8.9% developing PDC within 30-d after esophagectomy. Patients who experienced complications post-discharge had a median initial hospital length of stay (LOS) of 9 d; however, PDC occurred on average 14 d following surgery. Patients with PDC had greater rates of wound infection (41.0% vs 19.3%, P < 0.001), venous thromboembolism (16.3% vs 8.9%, P < 0.001), and organ space surgical site infection (17.1% vs 11.0%, P = 0.001) than patients with pre-discharge complication. The readmission rate in our entire population was 12.8%. PDC patients were overwhelmingly more likely to have a reoperation (39.5% vs 22.4%, P < 0.001) and readmission (66.9% vs 6.6%, P < 0.001). BMI 25-29.9 and BMI ≥ 30 were associated with increased risk of PDC compared to normal BMI (18.5-25).


CONCLUSIONS
PDC after esophagectomy account for significant number of reoperations and readmissions. Efforts should be directed towards optimizing patient's health pre-discharge, with possible prevention programs at discharge.
Sophia Y Chen, Miloslawa Stem, Benedetto Mungo, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
Sophia Y
SY
Chen
Sophia Y Chen, Miloslawa Stem, Benedetto Mungo, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
Daniela
D
Molena
Sophia Y Chen, Miloslawa Stem, Benedetto Mungo, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
Miloslawa
M
Stem
Sophia Y Chen, Miloslawa Stem, Benedetto Mungo, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
Benedetto
B
Mungo
Sophia Y Chen, Miloslawa Stem, Benedetto Mungo, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
Anne O
AO
Lidor
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016208:Databases, Factual; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
Esophagectomy; Hospital readmission; Outcomes research; Post-discharge complications; Reoperation