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Predictors of Kassis et al for Anastomotic Leak Following Esophagectomy

Description

Kassis et al reported factors predictive of anastomotic leak following an esophagectomy. These can help to identify a patent who may benefit from more aggressive management. The authors are from the Ohio State University, Duke University and the University of Maryland.


Patient selection: status post esophagectomy

 

Predictors of an anastomotic leak from multivariate analysis:

(1) heart failure (odds ratio 2.3)

(2) hypertension (odds ratio 1.5)

(3) renal insufficiency (odds ratio 2.9)

(4) type of procedure (cervical anastomosis odds ratio 1; thoracic anastomosis odds ratio 0.73)

 

The prognosis is worse if the leak requires surgical management (12% vs 4% for medically managed).

 

Nonfatal complications:

(1) atrial and/or ventricular arrhythmia

(2) deep vein thrombosis

(3) pneumonia

(4) ARDS

(5) empyema

(6) sepsis

(7) worsening of renal function

(8) esophageal stenosis or stricture requiring dilation before discharge

(9) need for reintubation and/or ventilator support > 48 hours


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