Document Detail


Outcomes after esophagectomy: a ten-year prospective cohort.
MedLine Citation:
PMID:  12537219     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Department of Veterans Affairs National Surgical Quality Improvement Program is a unique resource to prospectively analyze surgical outcomes from a cross-section of surgical services nationally. We used this database to assess risk factors for morbidity and mortality after esophagectomy in Veterans Affairs Medical Centers from 1991 to 2001. METHODS: A total of 1,777 patients underwent an esophagectomy at 109 Veterans Affairs hospitals with complete in-hospital and 30-day outcomes recorded. Bivariate and multivariable analyses were completed. RESULTS: Thirty-day mortality was 9.8% (174/1,777) and the incidence of one or more of 20 predefined complications was 49.5% (880/1,777). The most frequent postoperative complications were pneumonia in 21% (380/1,777), respiratory failure in 16% (288/1,777), and ventilator support more than 48 hours in 22% (387/1,777). Preoperative predictors of mortality based on multivariable analysis included neoadjuvant therapy, blood urea nitrogen level of more than 40 mg/dL, alkaline phosphatase level of more than 125 U/L, diabetes mellitus, alcohol abuse, decreased functional status, ascites, and increasing age. Preoperative factors impacting morbidity were increasing age, dyspnea, diabetes mellitus, chronic obstructive pulmonary disease, alkaline phosphatase level of more than 125 U/L, lower serum albumin concentration, increased complexity score, and decreased functional status. Intraoperative risk factors for mortality included the need for transfusion; intraoperative risk factors for morbidity included the need for transfusion and longer operative time. CONCLUSIONS: These data constitute the largest prospective outcomes cohort in the literature and document a near 50% morbidity rate and 10% mortality rate after esophagectomy. Data from this study can be used to better stratify patients before esophagectomy.
Authors:
Stephen H Bailey; David A Bull; David H Harpole; Jeffrey J Rentz; Leigh A Neumayer; Theodore N Pappas; Jennifer Daley; William G Henderson; Barbara Krasnicka; Shukri F Khuri
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  75     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-22     Completed Date:  2003-02-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  217-22; discussion 222     Citation Subset:  AIM; IM    
Affiliation:
Veterans Affairs Medical Center, University of Utah Medical School, Salt Lake City, Utah 84132, USA.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Alcoholism / complications
Alkaline Phosphatase / blood
Ascites / complications
Blood Urea Nitrogen
Cohort Studies
Diabetes Complications
Dyspnea / complications
Esophagectomy* / mortality
Female
Humans
Male
Middle Aged
Multivariate Analysis
Pneumonia / etiology
Postoperative Complications
Prospective Studies
Pulmonary Disease, Chronic Obstructive / complications
Respiratory Insufficiency / etiology
Risk Factors
Serum Albumin / analysis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Serum Albumin; EC 3.1.3.1/Alkaline Phosphatase

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