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Preoperative risk factors for anastomotic leak after esophagectomy with gastric reconstruction: A 6-year national surgical quality improvement (NSQIP) database analysis.
- Source :
-
Surgery [Surgery] 2024 Jul; Vol. 176 (1), pp. 93-99. Date of Electronic Publication: 2024 May 07. - Publication Year :
- 2024
-
Abstract
- Background: Anastomotic leak is a serious complication after esophagectomy that has been associated with worse outcomes. However, identifying patients at increased risk for anastomotic leak remains challenging.<br />Methods: Patients were included from the 2016 to 2021 National Surgical Quality Improvement Project database who underwent elective esophagectomy with gastric reconstruction for cancer. A multivariable logistic regression model was used to identify risk factors associated with anastomotic leak.<br />Results: A total of 4,331 patients were included in the study, of whom 647 patients experienced anastomotic leak (14.9%). Multivariable logistic regression revealed higher odds of anastomotic leak with smoking (adjusted odds ratio 1.24, confidence interval 1.02-1.51, P = .031), modified frailty index-5 score of 1 (adjusted odds ratio 1.44, confidence interval 1.19-1.75, P = .002) or 2 (adjusted odds ratio 1.52, confidence interval 1.19-1.94, P = .000), and a McKeown esophagectomy (adjusted odds ratio 1.44, confidence interval 1.16-1.80, P = .001). Each 1,000/μL increase in white blood cell count was associated with a 7% increase in odds of anastomotic leak (adjusted odds ratio 1.07, confidence interval 1.03-1.10, P = .0005). Higher platelet counts were slightly protective, and each 10,000/ μL increase in platelet count was associated with 2% reduced odds of anastomotic leak (adjusted odds ratio 0.98, confidence interval 0.97-0.99, P = .001).<br />Conclusion: In this study, smoking status, frailty index, white blood cell count, McKeown esophagectomy, and platelet counts were all associated with the occurrence of anastomotic leak. These results can help to inform surgeons and patients of the true risk of developing anastomotic leak and potentially improve outcomes by providing evidence to improve preoperative characteristics, such as frailty.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Female
Male
Middle Aged
Risk Factors
Aged
Retrospective Studies
Plastic Surgery Procedures adverse effects
Stomach surgery
United States epidemiology
Logistic Models
Risk Assessment methods
Esophagectomy adverse effects
Anastomotic Leak etiology
Anastomotic Leak epidemiology
Quality Improvement
Databases, Factual
Esophageal Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1532-7361
- Volume :
- 176
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 38719700
- Full Text :
- https://doi.org/10.1016/j.surg.2024.03.029