Risk factors associated with missing post-esophagectomy hospital milestones

• Published in: The American journal of surgery Vol. 215; no. 5; pp. 953 - 957
• Main Authors: Siegal MD, Steve R., Dolan, James P., Dewey MS, Elizabeth N., Parmar, Abhisek D., Petcu NP, Aura, Tieu MD, Brandon H., Schipper MD, Paul H., Hunter MD, John G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2018; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Body mass; Body Mass Index; Clinical pathways; Comorbidity; Confidence intervals; Critical Pathways; Decision making; Esophageal cancer; Esophageal Neoplasms - surgery; Esophagectomy; Esophagus; Female; Gastrointestinal surgery; Hospital costs; Humans; Identification methods; Male; Middle Aged; Morbidity; Mortality; Neoplasm Staging; Oesophageal cancer; Oesophagectomy; Operative Time; Patients; Postoperative Complications - prevention & control; Ratios; Regression analysis; Regression models; Retrospective Studies; Risk analysis; Risk Factors; Risk management; Surgery; Tobacco; Tobacco Use Disorder - complications; Esophagectomy; Oesophageal cancer; Clinical pathways; Oesophagectomy; Esophageal cancer; Risk factors
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.01.036

Our institution utilizes an esophagectomy pathway to guide postoperative management. Our aim was to identify risk factors associated with missing pathway goals.
Retrospective review of esophagectomies from 2010 to 2015. Multivariate logistic regression models identified risk factors for missing postoperative milestones prior to discharge. Odds ratios of variables affecting goals were calculated.
Of the195 esophagectomies, the most common risk factor for missing milestones was BMI, followed by operating room time, clinical stage, tobacco pack-years, and open surgical approach. Missing any milestone on the expected postoperative day significantly increase the odds of missing a future milestone, regardless of other risk factors.
We have identified specific patient and operative factors that increase the risk of missing post-esophagectomy goals on time. Early identification of at-risk patients allows for pathway modification to avoid adverse outcomes and prolonged hospitalization. Analysis of meeting milestones early may allow for creation of accelerated pathways.
•Open surgery, BMI, tobacco use, stage, and surgery duration prolong hospitalization after esophagectomy.•Identification of at-risk patients may help alter postoperative care to avoid adverse outcomes.•Patients without risk factors may benefit from shortened postoperative hospitalizations.