90.11 Preoperative Esophageal Disease Increases Morbidity in Patients Undergoing Abdominal Surgery

Posted on January 26, 2017

A. Ramirez1, A. Tilak1, M. Sohn1, F. Turrentine1, R. S. Jones1  1University Of Virginia,School Of Medicine,Charlottesville, VA, USA 2University Of Virginia,School Of Medicine,Charlottesville, VA, USA

Introduction:  In North America the prevalence of gastroesophageal reflux disorder ranges from 18.1% to 27.8%. We measured the risks posed by preoperative esophageal disease to patients undergoing abdominal operations.

Methods:  2005-2014 ACS NSQIP data were merged with institutional Clinical Data Repository records to identify esophageal disease in surgical patients. Patients with gastro-esophageal reflux disorder, esophageal stricture, spasm, and diverticuli were categorized as having ‘mild-moderate’ disease while patients with achalasia, esophagitis, reflux esophagitis, esophageal ulcer, Barrett’s esophagus, and multiple diagnoses were categorized as having ‘severe’ disease. Thirty-day postoperative mortality and morbidity were modeled as a function of disease severity, adjusting for NSQIP risk of mortality or morbidity, demographic factors (age, sex, race/ethnicity), NSQIP targeted procedure groups, and open surgery indicator.

Results: Of 22,098 patients, 21.1% had preoperative esophageal disease (15.6% mild-moderate and 5.5% severe). Age, male sex, and African-American race were associated with postoperative morbidity in patients with esophageal disease (OR = 1.02, p < 0.001; OR = 1.41, p < 0.000; OR = 1.12, p < 0.032), respectively. Patients undergoing open procedures were more likely to have complications (OR = 2.55, p < 0.001). After adjustment, patients with preoperative mild-moderate and severe esophageal disease were 14% and 27% more likely to experience postoperative complications than patients without esophageal disease (p=0.034 and p=0.046), respectively. Esophageal disease was not associated with postoperative mortality.

Conclusion: Preoperative esophageal disease significantly increased the risk of postoperative complications. Surgeons should use increased caution with esophageal disease patients undergoing abdominal operations.