Impact of comorbidity on complications and outcomes of esophagoplasty

The purpose of the study was to assess the impact of comorbidity on esophagoplasty outcomes.

Materials and methods. The outcomes of 289 patients undergoing esophagoplasty for cancer (251) and benign diseases of the esophagus (48) were analyzed, the comorbidity, Charlson index and prognostic nutritional index were calculated.

Results. Comorbid diseases were detected in 92 patients (31.8%), the Charlson index in this group was 2.4±1.1. In the group without comorbidity it was 1.1±0.8. Postoperative somatic complications developed in 57 cases (19.7%), in comorbid-ity group — 22 patients (23.9%), without comorbidity — 35 people (17.8%). 32 patients died (11.1%). Cardiopulmonary complications occurred in all 12 fatal outcomes in comorbid patients, in half of them they became the main cause of death.

Somatic complications were in 15 (75%) of 20 fatal outcomes in patients without comorbidity, they became the cause of death in 6 (30%). The Charlson index in comorbid group was 2.0±1.2 versus 1.4±1.1 in the other patients (p=0.01). The presence of comorbidity and the Charlson index significantly infl uenced the outcome of the disease (p=0.02) with logistic probability of 0.6 and a smaller logit spread, as well as the occurrence of complications in the postoperative period (p = 0.04) with values of 0.9 and 0.7, respectively. The logistic probability of a fatal outcome was 0.96 in cardiovascular pathology, 0.3 in pulmonary pathology, and 0.04 in hepatitis (p = 0.0006). The logistic probability of postoperative complications in cardiovascular pathology was 0.85, in pulmonary pathology — 0.64, in hepatitis — 0.09 (p = 0.02). The logistic probability of a fatal outcome with the development of pulmonary complications was 0.02, cardiovascular complications — 0.09 (p = 0.0001). The Onodera’s prognostic nutritional index in comorbid patients was 43±9, in others — 44±4 (p = 0.5).

Conclusion: comorbidity was detected in one third of patients who underwent esophagoplasty. Cardiopulmonary complications cause death in half of the deceased patients with comorbidity. The Charlson Index proved to be the most sensitive and objective predictor of outcomes in patients with comorbid diseases.

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