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J Thorac Cardiovasc Surg 2009;137:587-596
© 2009 The American Association for Thoracic Surgery

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

^a Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
^b Division of Thoracic Surgery, University of Pennsylvania, Philadelphia, Pa
^c Duke Clinical Research Institute, Duke University, Durham, NC
^d Division of General Thoracic Surgery, Mayo Clinic School of Medicine, Rochester, Minn

Received for publication May 7, 2008; revisions received September 30, 2008; accepted for publication November 16, 2008.

^_* Address for reprints: Dr. Cameron D. Wright, Massachusetts General Hospital, Thoracic Surgery, Blake 1570, 55 Fruit Street, Boston, MA02114. (Email: wright.cameron{at}mgh.harvard.edu).

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.