Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure-targeted analysis

Bradley R. Hall, Laura E. Flores, Zachary S. Parshall, Valerie K. Shostrom, Chandrakanth Are, Bradley N. Reames

Research output: Contribution to journalArticle

Abstract

Background: Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak. Methods: Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak. Results: Of 915 patients included, 83% were male and the median age was 64 years. Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P <.001). Rates of reoperation (64% vs 11%, P <.001) and mortality (8% vs 2%, P =.001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P =.003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P =.019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P =.045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P =.028) were independently associated with anastomotic leak. Conclusion: Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.

Original languageEnglish (US)
Pages (from-to)661-669
Number of pages9
JournalJournal of Surgical Oncology
Volume120
Issue number4
DOIs
StatePublished - Jan 1 2019

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Anastomotic Leak
Esophagectomy
Neoplasms
Odds Ratio
Operative Time
Quality Improvement
Reoperation
Logistic Models
Databases
Morbidity
Mortality

Keywords

  • NSQIP
  • anastomotic leak
  • cancer
  • esophagectomy
  • risk factor

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Risk factors for anastomotic leak after esophagectomy for cancer : A NSQIP procedure-targeted analysis. / Hall, Bradley R.; Flores, Laura E.; Parshall, Zachary S.; Shostrom, Valerie K.; Are, Chandrakanth; Reames, Bradley N.

In: Journal of Surgical Oncology, Vol. 120, No. 4, 01.01.2019, p. 661-669.

Research output: Contribution to journalArticle

Hall, Bradley R. ; Flores, Laura E. ; Parshall, Zachary S. ; Shostrom, Valerie K. ; Are, Chandrakanth ; Reames, Bradley N. / Risk factors for anastomotic leak after esophagectomy for cancer : A NSQIP procedure-targeted analysis. In: Journal of Surgical Oncology. 2019 ; Vol. 120, No. 4. pp. 661-669.
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AU - Reames, Bradley N.

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AB - Background: Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak. Methods: Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak. Results: Of 915 patients included, 83% were male and the median age was 64 years. Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P <.001). Rates of reoperation (64% vs 11%, P <.001) and mortality (8% vs 2%, P =.001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P =.003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P =.019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P =.045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P =.028) were independently associated with anastomotic leak. Conclusion: Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.

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