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Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model.

Publication ,  Journal Article
Wright, CD; Kucharczuk, JC; O'Brien, SM; Grab, JD; Allen, MS; Society of Thoracic Surgeons General Thoracic Surgery Database,
Published in: J Thorac Cardiovasc Surg
March 2009

OBJECTIVE: To create a model for perioperative risk of esophagectomy for cancer using the Society of Thoracic Surgeons General Thoracic Database. METHODS: The Society of Thoracic Surgeons General Thoracic Database was queried for all patients treated with esophagectomy for esophageal cancer between January 2002 and December 2007. A multivariable risk model for mortality and major morbidity was constructed. RESULTS: There were 2315 esophagectomies performed by 73 participating centers. Hospital mortality was 63/2315 (2.7%). Major morbidity (defined as reoperation for bleeding [n = 12], anastomotic leak [n = 261], pneumonia [n = 188], reintubation [n = 227], ventilation beyond 48 hours [n = 71], or death [n = 63]) occurred in 553 patients (24%). Preoperative spirometry was obtained in 923/2315 (40%) of patients. A forced expiratory volume in 1 second < 60% of predicted was associated with major morbidity (P = .0044). Important predictors of major morbidity are: age 75 versus 55 (P = .005), black race (P = .08), congestive heart failure (P = .015), coronary artery disease (P = .017), peripheral vascular disease (P = .009), hypertension (P = .029), insulin-dependent diabetes (P = .009), American Society of Anesthesiology rating (P = .001), smoking status (P = .022), and steroid use (P = .026). A strong volume performance relationship was not observed for the composite measure of morbidity and mortality in this patient cohort. CONCLUSIONS: Thoracic surgeons participating in the Society of Thoracic Surgeons General Thoracic Database perform esophagectomy with a low mortality. We identified important predictors of major morbidity and mortality after esophagectomy for esophageal cancer. Volume alone is an inadequate proxy for quality assessment after esophagectomy.

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Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

March 2009

Volume

137

Issue

3

Start / End Page

587 / 595

Location

United States

Related Subject Headings

  • Risk Factors
  • Respiratory System
  • Prognosis
  • Postoperative Complications
  • Models, Statistical
  • Middle Aged
  • Male
  • Humans
  • Female
  • Esophagectomy
 

Citation

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MLA
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Wright, C. D., Kucharczuk, J. C., O’Brien, S. M., Grab, J. D., Allen, M. S., & Society of Thoracic Surgeons General Thoracic Surgery Database, . (2009). Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg, 137(3), 587–595. https://doi.org/10.1016/j.jtcvs.2008.11.042
Wright, Cameron D., John C. Kucharczuk, Sean M. O’Brien, Joshua D. Grab, Mark S. Allen, and Mark S. Society of Thoracic Surgeons General Thoracic Surgery Database. “Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model.J Thorac Cardiovasc Surg 137, no. 3 (March 2009): 587–95. https://doi.org/10.1016/j.jtcvs.2008.11.042.
Wright CD, Kucharczuk JC, O’Brien SM, Grab JD, Allen MS, Society of Thoracic Surgeons General Thoracic Surgery Database. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg. 2009 Mar;137(3):587–95.
Wright, Cameron D., et al. “Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model.J Thorac Cardiovasc Surg, vol. 137, no. 3, Mar. 2009, pp. 587–95. Pubmed, doi:10.1016/j.jtcvs.2008.11.042.
Wright CD, Kucharczuk JC, O’Brien SM, Grab JD, Allen MS, Society of Thoracic Surgeons General Thoracic Surgery Database. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg. 2009 Mar;137(3):587–595.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

March 2009

Volume

137

Issue

3

Start / End Page

587 / 595

Location

United States

Related Subject Headings

  • Risk Factors
  • Respiratory System
  • Prognosis
  • Postoperative Complications
  • Models, Statistical
  • Middle Aged
  • Male
  • Humans
  • Female
  • Esophagectomy