Risk factors for readmission following esophagectomy and gastrectomy for cancer

J F M Geerts; I van den Berg; A M J van Nistelrooij; S M Lagarde; B P L Wijnhoven

doi:10.1093/dote/doae101

Risk factors for readmission following esophagectomy and gastrectomy for cancer

Dis Esophagus. 2024 Nov 16:doae101. doi: 10.1093/dote/doae101. Online ahead of print.

Authors

J F M Geerts^{1

2}, I van den Berg¹, A M J van Nistelrooij¹, S M Lagarde¹, B P L Wijnhoven¹

Affiliations

¹ Department of Surgery, Erasmus MC - University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
² Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands.

PMID: 39550626
DOI: 10.1093/dote/doae101

Abstract

Introduction: Hospital readmission after surgery is a key quality indicator. This nationwide cohort study aimed to assess readmission rates following esophagectomy and gastrectomy for cancer and identify associated risk factors.

Methods: Data were extracted from the Dutch Upper GI Cancer Audit (DUCA) for patients with esophagogastric cancer who underwent esophagectomy or gastrectomy with curative intent between January 2011 and June 2016. Logistic regression analysis identified risk factors for 30-day readmission.

Results: In total, 5566 patients were included. Readmission within 30 days occurred in 483 of 3488 (13.8%) patients after esophagectomy and 243 of 2078 patients (11.7%) after gastrectomy. Both minor (Clavien Dindo 1-2) and major (Clavien Dindo ≥3) postoperative complications were independent predictors of readmission after esophagectomy (OR 2.99; 95%CI 2.23-4.02; p < 0.001 and OR 5.20; 95%CI 3.82-7.09; p < 0.001). Specific complications included pulmonary (OR 1.49; 95%CI 1.20-1.85; p < 0.001), gastrointestinal (OR 2.43; 95%CI 1.94-3.05; p < 0.001), and infectious (OR 2.27; 95%CI 1.60-3.22; p < 0.001). Prolonged length of stay (pLOS) was associated with higher readmission rates in patients without complications following esophagectomy (OR 1.91 95% CI 1.19-3.07; p = 0.008), but lower rates in those with complications (OR 0.65 95% CI 0.51-0.83; p < 0.001). For gastrectomy, postoperative complications were also linked to readmission (OR 3.18; 95%CI 2.30-4.40; p < 0.001), particularly gastrointestinal (OR 2.16; 95%CI 1.40-3.32; p < 0.001), and infectious (OR 3.80; 95%CI 2.53-5.71; p < 0.001).

Conclusion: Readmission after esophagogastric resection is common, particularly among patients with both minor and major postoperative complications. Prolonged stay after esophagectomy impacts readmission risk differently based on the presence of complications.

Keywords: esophageal cancer; esophagectomy; gastrectomy; gastric cancer; readmission; surgery.