Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa035.
The impact of preoperative co-morbidity on postoperative outcomes in patients with oesophageal cancer is uncertain. A population-based and nationwide cohort study was conducted to assess the influence of preoperative co-morbidity on the risk of reoperation or mortality within 90 days of surgery for oesophageal cancer.
This study enrolled 98 per cent of patients who had oesophageal cancer surgery between 1987 and 2015 in Sweden. Modified Poisson regression models provided risk ratios (RRs) with 95 per cent confidence intervals (c.i.) to estimate associations between co-morbidity and risk of reoperation or death within 90 days of oesophagectomy. The RRs were adjusted for age, sex, educational level, pathological tumour stage, neoadjuvant therapy, annual hospital volume, tumour histology and calendar period of surgery.
Among 2576 patients, 446 (17.3 per cent) underwent reoperation or died within 90 days of oesophagectomy. Patients with a Charlson Co-morbidity Index (CCI) score of 2 or more had an increased risk of reoperation or death compared with those with a CCI score of 0 (RR 1.78, 95 per cent c.i. 1.44 to 2.20), and the risk increased on average by 27 per cent for each point increase of the CCI (RR 1.27, 1.18 to 1.37). The RR was increased in patients with pulmonary disease (RR 1.66, 1.36 to 2.04), cardiac disease (RR 1.37, 1.08 to 1.73), diabetes (RR 1.50, 1.14 to 1.99) and cerebral disease (RR 1.40, 1.06 to 1.85).
Co-morbidity in general, and pulmonary disease, cardiac disease, diabetes and cerebral disease in particular, increased the risk of reoperation or death within 90 days of oesophageal cancer surgery. This highlights the value of tailored patient selection, preoperative preparation and postoperative care.
术前合并症对食管癌患者术后结局的影响尚不确定。本项基于人群和全国性队列研究旨在评估术前合并症对食管癌手术后 90 天内再次手术或死亡风险的影响。
本研究纳入了 1987 年至 2015 年间在瑞典接受食管癌手术的 98%患者。采用校正泊松回归模型计算风险比（RR）及其 95%置信区间（CI），以评估合并症与食管癌手术后 90 天内再次手术或死亡风险之间的相关性。RR 经年龄、性别、教育程度、病理肿瘤分期、新辅助治疗、医院年手术量、肿瘤组织学和手术时间校正。
在 2576 例患者中，446 例（17.3%）在食管癌手术后 90 天内再次手术或死亡。Charlson 合并症指数（CCI）评分≥2 分的患者与 CCI 评分 0 分的患者相比，再次手术或死亡风险增加（RR 1.78，95%CI 1.44 至 2.20），CCI 每增加 1 分，风险平均增加 27%（RR 1.27，1.18 至 1.37）。患有肺部疾病（RR 1.66，1.36 至 2.04）、心脏疾病（RR 1.37，1.08 至 1.73）、糖尿病（RR 1.50，1.14 至 1.99）和脑部疾病（RR 1.40，1.06 至 1.85）的患者 RR 增加。
一般而言，合并症，尤其是肺部疾病、心脏疾病、糖尿病和脑部疾病，增加了食管癌手术后 90 天内再次手术或死亡的风险。这凸显了患者选择、术前准备和术后护理的重要性。
