CONCURRENT JEJUNOSTOMY AT THE TIME OF ESOPHAGECTOMY IS ASSOCIATED WITH IMPROVED SHORT TERM PERIOPERATIVE OUTCOMES: ANALYSIS OF THE NSQIP DATABASE
Michael Watson1, Sally J. Trufan2, Nicole Gower1, Lauren A. Jeck1, Benjamin M. Motz*1, Joshua S. Hill1, Jonathan Salo1
1Division of Surgical Oncology, Department of Surgey, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; 2Department of Biostatistics, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC
Background:
Adequate preoperative and perioperative nutrition has been shown to improve outcomes for patients undergoing esophagectomy. The most effective way to provide enteral nutrition for patients with esophageal obstruction and after esophagectomy is via jejunostomy tube. There is still debate over the most appropriate time for jejunostomy tube placement for patients undergoing esophagectomy.
Objectives:
The aim of this study is to compare short term outcomes for patients undergoing esophagectomy with and without concurrent jejunostomy tube placement. Our hypothesis is that patients undergoing concurrent jejunostomy tube placement at esophagectomy would have improved short-term outcomes.
Methods:
Using the NSQIP database from 2005 through 2016, we identified patients with esophageal cancer that underwent esophagectomy based on CPT coding. These patients were divided into two groups: patients with concurrent jejunostomy tube placement and those without jejunostomy placement at the time of esophagectomy. Demographic data, perioperative comorbidities, presence of preoperative weight loss, and anastomotic location were evaluated. Using univariate and multivariate analysis, the difference between short term outcomes including prolonged hospital stay (>30 days), in-hospital mortality, and 30-day mortality was determined.
Results:
8,632 (6,869 [80%] male) patients underwent esophagectomy for esophageal cancer with an average age of 63.2 ± 10.6. There were 3,672 cervical anastomoses, 3,550 thoracic anastomoses, and 1,009 abdominal anastomoses. 1,723 had preoperative weight loss; unintentional weight loss of >10% body weight in the 6-month period preceding surgery. The rate of concurrent jejunostomy at esophagectomy was 45% (3,900 patients). Overall rate of prolonged hospital stay was 5.9%, 5.0% for patients with concurrent jejunostomy and 6.6% for patients without concurrent jejunostomy (Chi square 7.5, p= 0.006). Overall rate of in-hospital mortality was 7.4%, 6.1% for patients with concurrent jejunostomy and 8.4% for patients without concurrent jejunostomy (Chi square 16.3, p< 0.001). Overall rate of 30-day mortality was 2.9%, 2.2% for patients with concurrent jejunostomy and 3.5% for patients without concurrent jejunostomy (Chi square 12.6, p< 0.001). Based on multivariate analysis, concurrent jejunostomy was associated with decreased rate of prolonged hospital stay (OR 0.79 [0.63-0.98]), decreased in-hospital mortality (OR 0.74 [0.63-0.88]) and decreased 30-day mortality (OR 0.65 [0.50-0.85]).
Conclusions:
Placement of a jejunostomy tube at esophagectomy was associated with decreased rates of prolonged hospital stay, decreased rate of in-hospital mortality, and decreased rate of 30-day mortality. This study demonstrates that patients with concurrent jejunostomy placement at the time of esophagectomy have improved short term perioperative outcomes.
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