Predictors of Major Morbidity or Mortality after Resection for Esophageal Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Risk Adjustment Model

Daniel P. Raymond, Christopher W. Seder, Cameron D. Wright, Mitchell J. Magee, Andrzej S. Kosinski, Stephen D. Cassivi, Eric L. Grogan, Shanda H. Blackmon, Mark S. Allen, Bernard J. Park, William R. Burfeind, Andrew C. Chang, Malcolm M. DeCamp, David W. Wormuth, Felix G. Fernandez, Benjamin D. Kozower

Research output: Contribution to journalArticle

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Abstract

Background. The purpose of this analysis was to revise the model for perioperative risk for esophagectomy for cancer utilizing The Society of Thoracic Surgeons General Thoracic Surgery Database to provide enhanced risk stratification and quality improvement measures for contributing centers. Methods. The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for all patients treated for esophageal cancer with esophagectomy between July 1, 2011, and June 30, 2014. Multivariable risk models for major morbidity, perioperative mortality, and combined morbidity and mortality were created with the inclusion of surgical approach as a risk factor. Results. In all, 4,321 esophagectomies were performed by 164 participating centers. The most common procedures included Ivor Lewis (32.5%), transhiatal (21.7%), minimally invasive esophagectomy, Ivor Lewis type (21.4%), and McKeown (10.0%). Sixty-nine percent of patients received induction therapy. Perioperative mortality (inpatient and 30-day) was 135 of 4,321 (3.4%). Major morbidity occurred in 1,429 patients (33.1%). Major morbidities include unexpected return to operating (15.6%), anastomotic leak (12.9%), reintubation (12.2%), initial ventilation beyond 48 hours (3.5%), pneumonia (12.2%), renal failure (2.0%), and recurrent laryngeal nerve paresis (2.0%). Statistically significant predictors of combined major morbidity or mortality included age more than 65 years, body mass index 35 kg/m2 or greater, preoperative congestive heart failure, Zubrod score greater than 1, McKeown esophagectomy, current or former smoker, and squamous cell histology. Conclusion Thoracic surgeons participating in The Society of Thoracic Surgeons General Thoracic Surgery Database perform esophagectomy with low morbidity and mortality. McKeown esophagectomy is an independent predictor of combined postoperative morbidity or mortality. Revised predictors for perioperative outcome were identified to facilitate quality improvement processes and hospital comparisons.

Original languageEnglish (US)
Pages (from-to)207-214
Number of pages8
JournalAnnals of Thoracic Surgery
Volume102
Issue number1
DOIs
StatePublished - Jul 1 2016

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Risk Adjustment
Esophagectomy
Esophageal Neoplasms
Thoracic Surgery
Databases
Morbidity
Mortality
Quality Improvement
Recurrent Laryngeal Nerve
Anastomotic Leak
Paresis
Renal Insufficiency
Ventilation
Inpatients
Pneumonia
Histology
Body Mass Index
Thorax
Heart Failure
Epithelial Cells

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of Major Morbidity or Mortality after Resection for Esophageal Cancer : A Society of Thoracic Surgeons General Thoracic Surgery Database Risk Adjustment Model. / Raymond, Daniel P.; Seder, Christopher W.; Wright, Cameron D.; Magee, Mitchell J.; Kosinski, Andrzej S.; Cassivi, Stephen D.; Grogan, Eric L.; Blackmon, Shanda H.; Allen, Mark S.; Park, Bernard J.; Burfeind, William R.; Chang, Andrew C.; DeCamp, Malcolm M.; Wormuth, David W.; Fernandez, Felix G.; Kozower, Benjamin D.

In: Annals of Thoracic Surgery, Vol. 102, No. 1, 01.07.2016, p. 207-214.

Research output: Contribution to journalArticle

Raymond, DP, Seder, CW, Wright, CD, Magee, MJ, Kosinski, AS, Cassivi, SD, Grogan, EL, Blackmon, SH, Allen, MS, Park, BJ, Burfeind, WR, Chang, AC, DeCamp, MM, Wormuth, DW, Fernandez, FG & Kozower, BD 2016, 'Predictors of Major Morbidity or Mortality after Resection for Esophageal Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Risk Adjustment Model', Annals of Thoracic Surgery, vol. 102, no. 1, pp. 207-214. https://doi.org/10.1016/j.athoracsur.2016.04.055
Raymond, Daniel P. ; Seder, Christopher W. ; Wright, Cameron D. ; Magee, Mitchell J. ; Kosinski, Andrzej S. ; Cassivi, Stephen D. ; Grogan, Eric L. ; Blackmon, Shanda H. ; Allen, Mark S. ; Park, Bernard J. ; Burfeind, William R. ; Chang, Andrew C. ; DeCamp, Malcolm M. ; Wormuth, David W. ; Fernandez, Felix G. ; Kozower, Benjamin D. / Predictors of Major Morbidity or Mortality after Resection for Esophageal Cancer : A Society of Thoracic Surgeons General Thoracic Surgery Database Risk Adjustment Model. In: Annals of Thoracic Surgery. 2016 ; Vol. 102, No. 1. pp. 207-214.
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abstract = "Background. The purpose of this analysis was to revise the model for perioperative risk for esophagectomy for cancer utilizing The Society of Thoracic Surgeons General Thoracic Surgery Database to provide enhanced risk stratification and quality improvement measures for contributing centers. Methods. The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for all patients treated for esophageal cancer with esophagectomy between July 1, 2011, and June 30, 2014. Multivariable risk models for major morbidity, perioperative mortality, and combined morbidity and mortality were created with the inclusion of surgical approach as a risk factor. Results. In all, 4,321 esophagectomies were performed by 164 participating centers. The most common procedures included Ivor Lewis (32.5{\%}), transhiatal (21.7{\%}), minimally invasive esophagectomy, Ivor Lewis type (21.4{\%}), and McKeown (10.0{\%}). Sixty-nine percent of patients received induction therapy. Perioperative mortality (inpatient and 30-day) was 135 of 4,321 (3.4{\%}). Major morbidity occurred in 1,429 patients (33.1{\%}). Major morbidities include unexpected return to operating (15.6{\%}), anastomotic leak (12.9{\%}), reintubation (12.2{\%}), initial ventilation beyond 48 hours (3.5{\%}), pneumonia (12.2{\%}), renal failure (2.0{\%}), and recurrent laryngeal nerve paresis (2.0{\%}). Statistically significant predictors of combined major morbidity or mortality included age more than 65 years, body mass index 35 kg/m2 or greater, preoperative congestive heart failure, Zubrod score greater than 1, McKeown esophagectomy, current or former smoker, and squamous cell histology. Conclusion Thoracic surgeons participating in The Society of Thoracic Surgeons General Thoracic Surgery Database perform esophagectomy with low morbidity and mortality. McKeown esophagectomy is an independent predictor of combined postoperative morbidity or mortality. Revised predictors for perioperative outcome were identified to facilitate quality improvement processes and hospital comparisons.",
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T2 - A Society of Thoracic Surgeons General Thoracic Surgery Database Risk Adjustment Model

AU - Raymond, Daniel P.

AU - Seder, Christopher W.

AU - Wright, Cameron D.

AU - Magee, Mitchell J.

AU - Kosinski, Andrzej S.

AU - Cassivi, Stephen D.

AU - Grogan, Eric L.

AU - Blackmon, Shanda H.

AU - Allen, Mark S.

AU - Park, Bernard J.

AU - Burfeind, William R.

AU - Chang, Andrew C.

AU - DeCamp, Malcolm M.

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AU - Fernandez, Felix G.

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N2 - Background. The purpose of this analysis was to revise the model for perioperative risk for esophagectomy for cancer utilizing The Society of Thoracic Surgeons General Thoracic Surgery Database to provide enhanced risk stratification and quality improvement measures for contributing centers. Methods. The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for all patients treated for esophageal cancer with esophagectomy between July 1, 2011, and June 30, 2014. Multivariable risk models for major morbidity, perioperative mortality, and combined morbidity and mortality were created with the inclusion of surgical approach as a risk factor. Results. In all, 4,321 esophagectomies were performed by 164 participating centers. The most common procedures included Ivor Lewis (32.5%), transhiatal (21.7%), minimally invasive esophagectomy, Ivor Lewis type (21.4%), and McKeown (10.0%). Sixty-nine percent of patients received induction therapy. Perioperative mortality (inpatient and 30-day) was 135 of 4,321 (3.4%). Major morbidity occurred in 1,429 patients (33.1%). Major morbidities include unexpected return to operating (15.6%), anastomotic leak (12.9%), reintubation (12.2%), initial ventilation beyond 48 hours (3.5%), pneumonia (12.2%), renal failure (2.0%), and recurrent laryngeal nerve paresis (2.0%). Statistically significant predictors of combined major morbidity or mortality included age more than 65 years, body mass index 35 kg/m2 or greater, preoperative congestive heart failure, Zubrod score greater than 1, McKeown esophagectomy, current or former smoker, and squamous cell histology. Conclusion Thoracic surgeons participating in The Society of Thoracic Surgeons General Thoracic Surgery Database perform esophagectomy with low morbidity and mortality. McKeown esophagectomy is an independent predictor of combined postoperative morbidity or mortality. Revised predictors for perioperative outcome were identified to facilitate quality improvement processes and hospital comparisons.

AB - Background. The purpose of this analysis was to revise the model for perioperative risk for esophagectomy for cancer utilizing The Society of Thoracic Surgeons General Thoracic Surgery Database to provide enhanced risk stratification and quality improvement measures for contributing centers. Methods. The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for all patients treated for esophageal cancer with esophagectomy between July 1, 2011, and June 30, 2014. Multivariable risk models for major morbidity, perioperative mortality, and combined morbidity and mortality were created with the inclusion of surgical approach as a risk factor. Results. In all, 4,321 esophagectomies were performed by 164 participating centers. The most common procedures included Ivor Lewis (32.5%), transhiatal (21.7%), minimally invasive esophagectomy, Ivor Lewis type (21.4%), and McKeown (10.0%). Sixty-nine percent of patients received induction therapy. Perioperative mortality (inpatient and 30-day) was 135 of 4,321 (3.4%). Major morbidity occurred in 1,429 patients (33.1%). Major morbidities include unexpected return to operating (15.6%), anastomotic leak (12.9%), reintubation (12.2%), initial ventilation beyond 48 hours (3.5%), pneumonia (12.2%), renal failure (2.0%), and recurrent laryngeal nerve paresis (2.0%). Statistically significant predictors of combined major morbidity or mortality included age more than 65 years, body mass index 35 kg/m2 or greater, preoperative congestive heart failure, Zubrod score greater than 1, McKeown esophagectomy, current or former smoker, and squamous cell histology. Conclusion Thoracic surgeons participating in The Society of Thoracic Surgeons General Thoracic Surgery Database perform esophagectomy with low morbidity and mortality. McKeown esophagectomy is an independent predictor of combined postoperative morbidity or mortality. Revised predictors for perioperative outcome were identified to facilitate quality improvement processes and hospital comparisons.

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