Skip to main content
SSO 2024 Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Recorded for On-Demand Viewing
Recorded for On-Demand Viewing
Back

Upper Gastrointestinal (lips to ileocecal valve, including esophagus and stomach)

E463: Characterizing Conditional 90-Day Mortality and Associated Risk Factors After Discharge from Complex Esophageal and Gastric Cancer Surgery

Introduction: Esophageal and Gastric cancer surgery has high morbidity and mortality rates. Previous studies suggest 90-day mortality rates double 30-day rates but often account for patients hospitalized beyond 30 days. This research delves into conditional 90-day mortality risks post-operation in patients initially discharged from the hospital, positing that discharged patients have risk factors increasing 90-day mortality.

Methods: Using the National Cancer Database (NCDB), we studied patients who underwent curative-intent resection for esophageal and gastric malignancies, focusing on those alive at 30-days post-operation and discharged. The main outcome was conditional 90-day mortality. Risk factors were pinpointed using descriptive analyses and multivariable logistic regression models.

Results: Of 41,968 patients, 5,026 had esophageal cancer; 35,942 had gastric cancer with 90-day post-resection mortality rates of 2.15% and 3.14% respectively. Age impacted both groups significantly, with esophagectomy patients aged 63 vs 68 years and gastrectomy patients 68 vs 75 years (p < 0.001). Conditional 90-day mortality rates were higher under Medicare, 2.85% for esophageal (p = 0.03) 4.16% for gastric (p < 0.001), compared to private insurance's 1.41% and 1.90%. Gastric cancer conditional 90-day mortality was 2.30% in Academic and 5.34% in Community centers (p < 0.001). Mortality peaked at Stage 3 (3.39% for esophageal and 5.23% for gastric). Charlson Comorbidity Index and CACI scores showed a positive relationship with conditional 90-day mortality (p < 0.001 for gastric and p =). Esophageal and Gastric patient had a significant association with 30-day unplanned readmissions (p < 0.001).

Conclusions: A significant portion of esophageal and gastric cancer patients undergoing curative-intent resection face conditional 90-day mortality. Notable associations with this mortality include age, insurance, facility type, clinical stage, comorbidity scores, and 30-day readmission. This highlights the ongoing risk of post-discharge mortality and calls for further research and strategic interventions, possibly focusing on enhanced follow-up and coordinated care.

Learning Objectives:

  • Understand the implications of patients being discharged post-operation and the potential ongoing risks associated with the first 90 days after surgery.
  • Analyze the influence of patient demographics (like age), insurance types, facility types, clinical stages, and comorbidity on 90-day post-resection mortality rates for esophageal and gastric cancers.
  • Recognize the importance of early interventions, coordinated care, and enhanced follow-up for patients post-surgery, especially those with identified high-risk factors.