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Impact of Venous Thromboembolism on Outcomes After Esophagectomy for Esophageal Cancer
Abhishek Sundaram*1, Sarah Baker3, Ananth Srinivasan1, Ilya Berim2, Sumeet K. Mittal1
1Surgery, Creighton University, Omaha, NE; 2Pulmonology, Creighton University, Omaha, NE; 3ICU nursing, Creighton University, Omaha, NE
Background: Esophagectomy for esophageal cancer is one of the more morbid surgical procedures in practice today. Emphasis has been placed on preventing venous thromboembolism (VTE) after surgery. However, limited reports exist on how VTE impacts outcomes and resource utilization after esophagectomy.
Objective: Evaluate the impact of venous thromboembolism (VTE) on outcomes and resource utilization after esophagectomy for esophageal cancer.
Methods: Retrospective review of the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) 2011-12 database was performed to identify patients who underwent elective esophagectomy for esophageal cancer. Patient who developed deep venous thrombosis or pulmonary embolism within 30 days of surgery were categorized as having VTE.
Results: One thousand one hundred and three patients satisfied study criteria. Fifty-four patients (4.9%) developed VTE. VTE patients were significantly older (mean: 66.6 years vs. 63.9 years, p=0.04), more likely to have received neo adjuvant therapy (75% vs. 42%, p=0.02), had a preoperative myocardial infarction (8.3% vs. 0.8%, p=0.009) and have a higher American Society of Anesthesiologists' (ASA) class (p<0.001), than patients without VTE. There was no significant difference between the groups in terms of gender, type of esophagectomy performed, history of pulmonary disease. Operative time in minutes was longer in patients with VTE (mean: 393.5 vs. 354.6, p=0.03). Patients with VTE had a significantly higher incidence of postoperative pulmonary complications like pneumonia (25.9% vs. 13%, p=0.007), had difficulty being weaned of the ventilator (31.5% vs. 10.3%, p<0.001), and were more likely to be reintubated (25.9% vs. 10.5%, p<0.001). VTE patients have a significantly longer hospital stay (mean: 20.4 days vs. 14 days, p=0.01) and higher 30-day readmission rate (29.6% vs. 11.5%, p<0.001). Thirty-day mortality was higher in patients with VTE (5.5% vs. 3.05%, p=0.24). On multivariate regression analysis, ASA class was significantly (p=0.04) associated with VTE.
Conclusions: Patients undergoing esophagectomy for esophageal cancer are at a high risk for VTE. VTE significantly adds to the morbidity associated with an esophagectomy resulting in increased resource utilization. Stringent peri-operative prophylaxis is needed to combat this dreaded complication.
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