IF 3.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Andrea L Axtell, Clara Angeles, Daniel P McCarthy, James D Maloney, Glen E Leverson, Malcolm M DeCamp
{"title":"Anastomotic Leak after Esophagectomy - Analysis of the STS General Thoracic Surgery Database.","authors":"Andrea L Axtell, Clara Angeles, Daniel P McCarthy, James D Maloney, Glen E Leverson, Malcolm M DeCamp","doi":"10.1016/j.athoracsur.2024.12.019","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leak after esophagectomy is a major cause of morbidity and mortality. We sought to identify the prevalence of anastomotic leak, stratified by operative approach and disease etiology, as well as risk factors for leak.</p><p><strong>Methods: </strong>A retrospective cohort analysis using the STS General Thoracic Surgery Database was conducted on patients who underwent esophagectomy with gastric reconstruction between 2009-2021. Baseline characteristics and postoperative outcomes were compared between patients who did and did not develop an anastomotic leak. Multivariable mixed effects logistic regression models identified risk factors for leak.</p><p><strong>Results: </strong>Of 18,419 patients, 3,416 (19%) developed an anastomotic leak. Patients who leaked had more comorbidities including obesity and diabetes. There was no difference in leak based on disease etiology (p=0.435.) Patients with anastomotic leak had increased 30-day mortality (7% vs 4%, p<0.001), reoperation (58% vs 10%, p<0.001), and longer lengths of stay (18 vs 10 days, p<0.001). On multivariable analysis, obesity (OR 1.27[1.16-1.38], p<0.001), diabetes (OR 1.14[1.04-1.25], p=0.006), and smoking (OR 1.26[1.15-1.37], p<0.001) were independently predictive of anastomotic leak. Compared to an open 2-field, a transhiatal (OR 1.35[1.17-1.55], p<0.001) or 3-field esophagectomy (OR 1.46[1.25-1.70], p<0.001) was more likely to leak. A robotic approach was associated with an increased risk of leak (OR 1.28[1.03-1.08], p<0.001), however lost significance in a modern subgroup from 2018-2021.</p><p><strong>Conclusions: </strong>Obesity, diabetes, smoking, pulmonary hypertension, and a cervical anastomosis are risk factors for anastomotic leak regardless of disease etiology. These important clinical risk factors identify an opportunity for modifiable risk reduction with aggressive medical optimization perioperatively.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Thoracic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.athoracsur.2024.12.019","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

摘要

背景:食管切除术后吻合口漏是发病和死亡的主要原因。我们试图确定吻合口漏的发生率(按手术方法和疾病病因分层)以及导致吻合口漏的风险因素:我们利用 STS 普通胸外科数据库对 2009-2021 年间接受食管切除术和胃重建术的患者进行了回顾性队列分析。对出现和未出现吻合口漏的患者的基线特征和术后结果进行了比较。多变量混合效应逻辑回归模型确定了吻合口漏的风险因素:在 18419 名患者中,有 3416 人(19%)出现吻合口漏。发生吻合口漏的患者合并症较多,包括肥胖和糖尿病。吻合口漏患者的 30 天死亡率增加(7% 对 4%,P=0.435):无论疾病病因如何,肥胖、糖尿病、吸烟、肺动脉高压和宫颈吻合术都是造成吻合口漏的风险因素。这些重要的临床风险因素为在围手术期通过积极的医疗优化降低风险提供了机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anastomotic Leak after Esophagectomy - Analysis of the STS General Thoracic Surgery Database.

Background: Anastomotic leak after esophagectomy is a major cause of morbidity and mortality. We sought to identify the prevalence of anastomotic leak, stratified by operative approach and disease etiology, as well as risk factors for leak.

Methods: A retrospective cohort analysis using the STS General Thoracic Surgery Database was conducted on patients who underwent esophagectomy with gastric reconstruction between 2009-2021. Baseline characteristics and postoperative outcomes were compared between patients who did and did not develop an anastomotic leak. Multivariable mixed effects logistic regression models identified risk factors for leak.

Results: Of 18,419 patients, 3,416 (19%) developed an anastomotic leak. Patients who leaked had more comorbidities including obesity and diabetes. There was no difference in leak based on disease etiology (p=0.435.) Patients with anastomotic leak had increased 30-day mortality (7% vs 4%, p<0.001), reoperation (58% vs 10%, p<0.001), and longer lengths of stay (18 vs 10 days, p<0.001). On multivariable analysis, obesity (OR 1.27[1.16-1.38], p<0.001), diabetes (OR 1.14[1.04-1.25], p=0.006), and smoking (OR 1.26[1.15-1.37], p<0.001) were independently predictive of anastomotic leak. Compared to an open 2-field, a transhiatal (OR 1.35[1.17-1.55], p<0.001) or 3-field esophagectomy (OR 1.46[1.25-1.70], p<0.001) was more likely to leak. A robotic approach was associated with an increased risk of leak (OR 1.28[1.03-1.08], p<0.001), however lost significance in a modern subgroup from 2018-2021.

Conclusions: Obesity, diabetes, smoking, pulmonary hypertension, and a cervical anastomosis are risk factors for anastomotic leak regardless of disease etiology. These important clinical risk factors identify an opportunity for modifiable risk reduction with aggressive medical optimization perioperatively.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Annals of Thoracic Surgery
Annals of Thoracic Surgery 医学-呼吸系统
CiteScore
6.40
自引率
13.00%
发文量
1235
审稿时长
42 days
期刊介绍: The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信