Risk factor analysis of post-operative mortality in oesophagectomy

Oesophagectomy for cancer is associated with a significant incidence of pos t-operative complications and death, and so this study sought to determine objective criteria which could better predict operative risk. Clinical risk factors for oesophagectomy and the results of objective investigations wer e assessed prospectively by independent surgical and intensive care special ists and a multivariate analysis was used to develop a scoring system for p redicting operative risk. From September 1994 to June 1997, 32 patients fro m an overall experience of 70 oesophagectomy procedures for cancer at the R oyal Adelaide Hospital were entered into this study. Hypertension, a histor y of previous cigarette smoking and FEV1/FVC were identified as independent predictors of the post-operative outcome. Age and FEV1/FVC were also signi ficantly associated with the occurrence of cardiovascular and pulmonary com plications respectively. The average risk score was 4.8 +/- 4.5 (mean +/- S D) for patients who died, 2.9 +/- 2.9 for patients who developed post-opera tive complications and 2.6 +/- 2.1 for patients who had an uncomplicated re covery. The likelihood of post-operative mortality and morbidity was highes t in patients with a score of 5 or more. Mortality rates of different patie nt groups undergoing oesophagectomy by the same surgeons during the same ti me period were also compared, showing greatly different mortality rates. Im portant risk factors can be identified preoperatively, and a scoring system can be used to provide objective criteria which can be used to identify pa tients at an increased risk of post-operative complications and death. A pr ospective study of this scoring system is now needed to determine whether i t proves useful in rejecting patients for surgery who would otherwise have undergone oesophagectomy.