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Reducing hospital morbidity and mortality following esophagectomy.

Publication ,  Journal Article
Atkins, BZ; Shah, AS; Hutcheson, KA; Mangum, JH; Pappas, TN; Harpole, DH; D'Amico, TA
Published in: Ann Thorac Surg
October 2004

BACKGROUND: Esophagogastrectomy (EG) is a formidable operation with significant morbidity and mortality rates. Risk factor analyses have been performed, but few studies have produced strategies that have improved operative results. This study was performed in order to identify prognostic variables that might be used to develop a strategy for optimizing outcomes after EG. METHODS: The records of all patients (n = 379) who underwent EG patients at a tertiary medical center between 1996 and 2002 were retrospectively reviewed. Thirty-day morbidity and mortality were determined, and multivariable logistical regression analysis assessed the effect of preoperative and postoperative variables on early mortality. RESULTS: Operations included Ivor Lewis (n = 179), transhiatal (n = 130), and other approaches (n = 70). Operative mortality was 5.8%; 64% experienced complications, including respiratory complications (28.5%), anastamotic strictures (25%), and leak (14%). Increasing age, anastomotic leak, Charlson comorbidity index 3, worse swallowing scores, and pneumonia were associated with increased risk of mortality by univariate analysis. However, only age (p = 0.002) and pneumonia (p = 0.0008) were independently associated with mortality by multivariable analysis. Pneumonia was associated with a 20% incidence of death. Patients with pneumonia had significantly worse deglutition and anastomotic integrity on barium esophagogram compared with patients without pneumonia (p < 0.001, Mann-Whitney rank sum test). CONCLUSIONS: Morbidity and mortality of EG are significant, but most complications, including anastomotic leak, are not independent predictors of mortality. The most important complication after EG is pneumonia. Strategies to decrease postoperative mortality should include careful assessment of swallowing abnormalities and predisposition to aspiration by cineradiography or fiberoptic endoscopy. After EG, acceptable pharyngeal function and airway protection should be verified before resuming oral intake.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

October 2004

Volume

78

Issue

4

Start / End Page

1170 / 1176

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Prognosis
  • Postoperative Complications
  • Pneumonia, Aspiration
  • Pneumonia
  • Neoadjuvant Therapy
 

Citation

APA
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MLA
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Atkins, B. Z., Shah, A. S., Hutcheson, K. A., Mangum, J. H., Pappas, T. N., Harpole, D. H., & D’Amico, T. A. (2004). Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg, 78(4), 1170–1176. https://doi.org/10.1016/j.athoracsur.2004.02.034
Atkins, B Zane, Ashish S. Shah, Kelley A. Hutcheson, Jennifer H. Mangum, Theodore N. Pappas, David H. Harpole, and Thomas A. D’Amico. “Reducing hospital morbidity and mortality following esophagectomy.Ann Thorac Surg 78, no. 4 (October 2004): 1170–76. https://doi.org/10.1016/j.athoracsur.2004.02.034.
Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg. 2004 Oct;78(4):1170–6.
Atkins, B. Zane, et al. “Reducing hospital morbidity and mortality following esophagectomy.Ann Thorac Surg, vol. 78, no. 4, Oct. 2004, pp. 1170–76. Pubmed, doi:10.1016/j.athoracsur.2004.02.034.
Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH, D’Amico TA. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg. 2004 Oct;78(4):1170–1176.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

October 2004

Volume

78

Issue

4

Start / End Page

1170 / 1176

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Prognosis
  • Postoperative Complications
  • Pneumonia, Aspiration
  • Pneumonia
  • Neoadjuvant Therapy