Analysis On Risk Factors Of Preoperative Mortality For Esophagectomy And The Establishment Of Prediction Model

Objective: To discuss the causes and risk factors of esophageal cancer perioperative mortality,establishing logistics regression model.Methods : from January 2002 to December 2015,collect the clinical data of those patients who were diagnosed in our hospital as esophageal cancer and Accepted esophageal cancer resection surgery,850 cases of esophageal cancer,according to perioperative and hospitalization period outcomes,they are divided into non death of group and the death group;we analyzed retrospectively the 64 factors which may have a relevant effect on the surgery mortality of esophageal cancer;we established the logistics regression models with computer to study and analyze the risk factors associated with the causes of surgical death,and we separately carry out univariate,multivariate analysis,establish logistics regression model,and summarize the practical significance.Results: 850 cases of esophageal cancer,operative death is 39 cases,operative mortality is 4.59%;Univariate logistics regression analysis,64 factors analyzed,there are 25 factors are related with esophageal resection perioperative deaths,respectively,ethnicity,age,preoperative comorbidities,preoperative hemoglobin,surgical resection,anastomosis,anastomosis level,operation time,postoperative albumin,enteral nutrition time,ICU treatment time,arrhythmia,pneumonia,lung infection,severe pneumonia,unilateral pleural effusion,bilateral pleural effusion,septic shock,MODS,anastomotic fistula,chylothorax,respiratory failure,circulatory failure,respiratory and circulatory failure,ischemia and hypoxia syndrome,which showed statistically significant difference(p<0.05,specific variable definitions see below).Multivariate regression analysis showed that operation time,arrhythmia,postoperative albumin,enteral nutrition time,MODS,chylothorax,respiratory failure,etc statistically significant,P<0.05,which are the independent risk factors for obtain the prediction model: P=1/1+e^(2.951X25+1.922X27+0.445X30-2.066X32+4.313X50+2.333X55-2.689X58-8.999),(0≤P≤1).Conclusion: In the analysis of esophageal perioperative mortality causes,operation time,arrhythmia,postoperative albumin,enteral nutrition time,MODS,chylothorax,respiratory failure,etc,are the independent risk factors for the causes of esophageal cancer perioperative mortality and used into the regression equation to obtain the prediction model;To reduce perioperative mortality of esophageal cancer,it needs to improve the medical environment and enhance surgical techniques,meanwhile it the causes of esophageal cancer perioperative mortality and used into the regression equation to needs the preoperative,intraoperative and postoperative close observation and evaluation of postoperative albumin,and start the enteral nutrition time carefully and scientifically,actively prevent arrhythmia postoperative,MODS,chylothorax,respiratory failure and other complications,and take treatment as soon as possible.