Comparing Outcomes after Transthoracic and Transhiatal Esophagectomy: A 5-Year Prospective Cohort of 17,395 Patients

Rafe C. Connors, Brian C. Reuben, Leigh A Neumayer, David A. Bull

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

Background: Debate continues over whether transhiatal esophagectomy (THE) offers decreased morbidity and mortality compared with transthoracic esophagectomy (TTE). To definitively answer this question, we used the Nationwide Inpatient Sample database to compare morbidity and mortality after THE and TTE. Study Design: Using ICD-9 procedure codes, we queried the Nationwide Inpatient Sample database for patients undergoing THE and TTE. Multivariate statistical analysis was completed to compare morbidity, mortality, length of stay, and hospital volume analysis between the groups. Results: Between 1999 and 2003, 17,395 patients included in the Nationwide Inpatient Sample underwent esophagectomy. Mean patient age was similar in those undergoing THE and TTE (61.9 versus 62.0 years, respectively). Overall morbidity and mortality after esophagectomy were 50.7% and 8.8%, respectively. In-hospital mortality after THE was 8.91% compared with 8.47% after TTE (p = 0.642). Multivariate regression analysis showed no difference in the incidence of mediastinitis, wound, infectious, pulmonary, gastrointestinal, cardiovascular, systemic, procedure-related, or overall complications or hospital length of stay between the two groups. Controlling additionally for hospital volume showed high-volume centers (more than 10 esophagectomies per year) had significantly lower mortality rates than low-volume centers (10 or fewer esophagectomies per year, p = 0.024). Additionally, low-volume centers have a higher incidence of gastrointestinal and systemic complications in the TTE group (p = 0.048 and p = 0.038, respectively). Conclusions: This large-volume, multicenter study constitutes the largest cohort in the literature to compare outcomes after THE and TTE. These findings indicate the outcomes after THE and TTE for esophageal disease are equivalent, although higher-volume centers will have lower morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)735-740
Number of pages6
JournalJournal of the American College of Surgeons
Volume205
Issue number6
DOIs
StatePublished - Dec 2007
Externally publishedYes

Fingerprint

Esophagectomy
Mortality
Morbidity
Inpatients
Length of Stay
Multivariate Analysis
High-Volume Hospitals
Databases
Esophageal Diseases
Mediastinitis

ASJC Scopus subject areas

  • Surgery

Cite this

Comparing Outcomes after Transthoracic and Transhiatal Esophagectomy : A 5-Year Prospective Cohort of 17,395 Patients. / Connors, Rafe C.; Reuben, Brian C.; Neumayer, Leigh A; Bull, David A.

In: Journal of the American College of Surgeons, Vol. 205, No. 6, 12.2007, p. 735-740.

Research output: Contribution to journalArticle

@article{55897247fd714cd2a8a5ce79bf6b3da8,
title = "Comparing Outcomes after Transthoracic and Transhiatal Esophagectomy: A 5-Year Prospective Cohort of 17,395 Patients",
abstract = "Background: Debate continues over whether transhiatal esophagectomy (THE) offers decreased morbidity and mortality compared with transthoracic esophagectomy (TTE). To definitively answer this question, we used the Nationwide Inpatient Sample database to compare morbidity and mortality after THE and TTE. Study Design: Using ICD-9 procedure codes, we queried the Nationwide Inpatient Sample database for patients undergoing THE and TTE. Multivariate statistical analysis was completed to compare morbidity, mortality, length of stay, and hospital volume analysis between the groups. Results: Between 1999 and 2003, 17,395 patients included in the Nationwide Inpatient Sample underwent esophagectomy. Mean patient age was similar in those undergoing THE and TTE (61.9 versus 62.0 years, respectively). Overall morbidity and mortality after esophagectomy were 50.7{\%} and 8.8{\%}, respectively. In-hospital mortality after THE was 8.91{\%} compared with 8.47{\%} after TTE (p = 0.642). Multivariate regression analysis showed no difference in the incidence of mediastinitis, wound, infectious, pulmonary, gastrointestinal, cardiovascular, systemic, procedure-related, or overall complications or hospital length of stay between the two groups. Controlling additionally for hospital volume showed high-volume centers (more than 10 esophagectomies per year) had significantly lower mortality rates than low-volume centers (10 or fewer esophagectomies per year, p = 0.024). Additionally, low-volume centers have a higher incidence of gastrointestinal and systemic complications in the TTE group (p = 0.048 and p = 0.038, respectively). Conclusions: This large-volume, multicenter study constitutes the largest cohort in the literature to compare outcomes after THE and TTE. These findings indicate the outcomes after THE and TTE for esophageal disease are equivalent, although higher-volume centers will have lower morbidity and mortality.",
author = "Connors, {Rafe C.} and Reuben, {Brian C.} and Neumayer, {Leigh A} and Bull, {David A.}",
year = "2007",
month = "12",
doi = "10.1016/j.jamcollsurg.2007.07.001",
language = "English (US)",
volume = "205",
pages = "735--740",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Comparing Outcomes after Transthoracic and Transhiatal Esophagectomy

T2 - A 5-Year Prospective Cohort of 17,395 Patients

AU - Connors, Rafe C.

AU - Reuben, Brian C.

AU - Neumayer, Leigh A

AU - Bull, David A.

PY - 2007/12

Y1 - 2007/12

N2 - Background: Debate continues over whether transhiatal esophagectomy (THE) offers decreased morbidity and mortality compared with transthoracic esophagectomy (TTE). To definitively answer this question, we used the Nationwide Inpatient Sample database to compare morbidity and mortality after THE and TTE. Study Design: Using ICD-9 procedure codes, we queried the Nationwide Inpatient Sample database for patients undergoing THE and TTE. Multivariate statistical analysis was completed to compare morbidity, mortality, length of stay, and hospital volume analysis between the groups. Results: Between 1999 and 2003, 17,395 patients included in the Nationwide Inpatient Sample underwent esophagectomy. Mean patient age was similar in those undergoing THE and TTE (61.9 versus 62.0 years, respectively). Overall morbidity and mortality after esophagectomy were 50.7% and 8.8%, respectively. In-hospital mortality after THE was 8.91% compared with 8.47% after TTE (p = 0.642). Multivariate regression analysis showed no difference in the incidence of mediastinitis, wound, infectious, pulmonary, gastrointestinal, cardiovascular, systemic, procedure-related, or overall complications or hospital length of stay between the two groups. Controlling additionally for hospital volume showed high-volume centers (more than 10 esophagectomies per year) had significantly lower mortality rates than low-volume centers (10 or fewer esophagectomies per year, p = 0.024). Additionally, low-volume centers have a higher incidence of gastrointestinal and systemic complications in the TTE group (p = 0.048 and p = 0.038, respectively). Conclusions: This large-volume, multicenter study constitutes the largest cohort in the literature to compare outcomes after THE and TTE. These findings indicate the outcomes after THE and TTE for esophageal disease are equivalent, although higher-volume centers will have lower morbidity and mortality.

AB - Background: Debate continues over whether transhiatal esophagectomy (THE) offers decreased morbidity and mortality compared with transthoracic esophagectomy (TTE). To definitively answer this question, we used the Nationwide Inpatient Sample database to compare morbidity and mortality after THE and TTE. Study Design: Using ICD-9 procedure codes, we queried the Nationwide Inpatient Sample database for patients undergoing THE and TTE. Multivariate statistical analysis was completed to compare morbidity, mortality, length of stay, and hospital volume analysis between the groups. Results: Between 1999 and 2003, 17,395 patients included in the Nationwide Inpatient Sample underwent esophagectomy. Mean patient age was similar in those undergoing THE and TTE (61.9 versus 62.0 years, respectively). Overall morbidity and mortality after esophagectomy were 50.7% and 8.8%, respectively. In-hospital mortality after THE was 8.91% compared with 8.47% after TTE (p = 0.642). Multivariate regression analysis showed no difference in the incidence of mediastinitis, wound, infectious, pulmonary, gastrointestinal, cardiovascular, systemic, procedure-related, or overall complications or hospital length of stay between the two groups. Controlling additionally for hospital volume showed high-volume centers (more than 10 esophagectomies per year) had significantly lower mortality rates than low-volume centers (10 or fewer esophagectomies per year, p = 0.024). Additionally, low-volume centers have a higher incidence of gastrointestinal and systemic complications in the TTE group (p = 0.048 and p = 0.038, respectively). Conclusions: This large-volume, multicenter study constitutes the largest cohort in the literature to compare outcomes after THE and TTE. These findings indicate the outcomes after THE and TTE for esophageal disease are equivalent, although higher-volume centers will have lower morbidity and mortality.

UR - http://www.scopus.com/inward/record.url?scp=36148963600&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=36148963600&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2007.07.001

DO - 10.1016/j.jamcollsurg.2007.07.001

M3 - Article

C2 - 18035255

AN - SCOPUS:36148963600

VL - 205

SP - 735

EP - 740

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 6

ER -