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PURPOSE: Our aim was to determine what specific patient and perioperative factors contribute to major complications after esophagectomy. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, data for esophagectomies between the years 2005-2007 was extracted and analyzed. 30-day postoperative complications were classified into seven major groups: wound infections, respiratory complications (pneumonia, intubation), cardiac complications, deep venous thrombosis (DVT), sepsis/septic shock, re-operation and death. Univariate analysis and logistic regression modeling was performed to determine if a significant association existed between patient and perioperative factors and the postoperative complication groups.RESULTS: 628 patients who had undergone esophagectomy were identified. Diabetes was the strongest independent predictor for death and respiratory or cardiac complications following esophagectomy.Thoracotomy performed during the operation was not associated with an increased risk of respiratory or cardiac complications. CONCLUSIONS: Stringent preoperative management of diabetes and peripheral vascular disease as well as diagnosis and treatment of dyspnea may yield significant postoperative benefit in terms of reducing complications in patients undergoing esophagectomy.
Table 1. Patient and perioperative factors associated with morbidity and death following esophagectomy.

Patient or perioperative factor	Complication	P value	Odds ratio (95% CI)
Age	Death	<.01	1.123 (1.042-1.224)
Diabetes	Sepsis/septic shock	0.06	2.139 (0.945-4.736)
	Respiratory	0.02	2.390 (1.099-5.189)
	Cardiac	<.01	6.728 (1.663-27.664)
	Death	0.02	6.789 (1.137-39.543)
Dyspnea	Respiratory	0.06	2.266 (0.949-5.444)
	Death	0.03	5.011 (1.076-22.962)
Peripheral vascular disease	Re-operation	0.01	5.193 (1.369-18.310)
	Wound infection	<.01	5.826 (1.995-17.682)
Steroid use	Sepsis/septic shock	0.04	6.302 (1.147-49.143)
Prior cardiac surgery	Sepsis/septic shock	0.04	2.387 (1.006-5.580)
Radiation <90 days preoperatively	Wound infection	<.01	2.043 (1.283-3.241)
Preoperative serum bilirubin (mg/dl)	Re-operation	0.03	1.753 (1.055-3.089)
	Death	0.06	2.476 (1.007-8.211)
Preoperative WBC count (k/ml)	Cardiac	0.04	1.161 (1.007-1.351)
Preoperative hematrocrit (%)	Wound infection	0.03	1.045 (1.003-1.089)
ASA class III	Sepsis/septic shock	0.02	2.508 (1.147-6.131)
Thoracotomy	Re-operation	0.04	1.961 (1.073-3.695)
Intraoperative Blood Transfusion	DVT	0.04	1.197 (1.004-1.431)
	Cardiac	0.02	1.284 (1.012-1.598)
	Death	<.01	33.455 (4.133-297.148)