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TOTAL AND PARTIAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: AN ANALYSIS OF READMISSIONS
Khuzema Mohsin*1, Oumar Thiero2, Christopher DuCoin1
1Surgery, Tulane University School of Medicine, New Orleans, LA; 2Biostatistics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
Introduction
Esophageal cancer is one of the most common forms of cancer worldwide and has high mortality rates. After careful staging patients, surgery may be curative for cases of localized disease, with or without radiation and chemotherapy. For surgical candidates, it remains unclear weather total esophagectomy or partial esophagectomy is the superior modality for management.
Methods
We queried the National Readmission Database (NRD) for adult patients undergoing esophageal resection for esophageal cancer diagnoses from 2010 to 2014. The NRD, by the Healthcare Cost and Utilization Project, follows patients across time over one-year intervals to allow for analyses of national readmission rates for all payers and the uninsured. Primary outcome was set as 30-day non-elective readmission.
Results
A total of 9,974 weighted cases of esophagectomy for esophageal cancer were included. 30.9% had total resection. Mortality rate was 4.0% for partial resection patients and 5.2% for total resection patients (p=0.2). 16.2% of patients were readmitted within 30 days of surgery. Mean and median time to readmission was 10.7(SEM: 0.4) and 8.2(SEM: 0.48) days, respectively. 21.2% of patients were readmitted to a hospital other than where the surgery was performed. On multivariate analysis assessing for which cases received total resection compared to partial, patients were less likely to have total resection if they had higher Charlson Comorbidity Index(CCI) (OR: 0.96, p<0.01) or if they were at small bedsize hospitals compared to large bedsize hospitals (OR: 0.5, p=0.01); non-electively admitted patients were more likely to have total resection compared to partial (OR: 1.6, p<0.01). On multivariate analysis modeling for readmission, patients who had total resection did not differ in rates of readmission compared to patients who had partial resection (OR: 1.2, p=0.14). Other factors associated with readmission included increasing CCI (OR: 1.06, p<0.01), increasing total number of chronic conditions (OR: 1.1, p<0.01) and increased length of stay (OR: 1.01, p<0.01). Hospital esophagectomy volume was not associated with readmission (p=0.74). The most common reasons for readmission were other postoperative infections including wound infections, pneumonia, unspecified digestive system complications, pneumonitis and pleural infusion. 8.5% of patients developed recurrence within the 30-day readmission period, 9.1% and 7.1% of partial and total resection patients, respectively.
Conclusion
Esophageal cancer patients having total or partial esophageal resection for esophageal cancer have similar rates of readmission. Patients with higher CCI, greater number of chronic conditions, and longer hospital stay during surgical visit are at higher risk for readmission.
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