Novel Prediction of Postoperative Pneumonia in Elderly Patients With Esophageal Cancer Undergoing Minimally Invasive Esophagectomy Using Dementia Assessment Sheet for Community-Based Integrated Care System 21-Items (DASC-21).

BACKGROUND

Preoperative risk assessment is particularly crucial in elderly patients, who often present with comorbidities and organ dysfunction. We investigated the utility of Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) in predicting postoperative pneumonia in elderly patients undergoing esophagectomy for esophageal cancer.

PATIENTS AND

METHODS

We retrospectively analyzed 60 patients aged ≥ 75 years who underwent esophagectomy for esophageal cancer between May 2019 and March 2025 at Wakayama Medical University Hospital. The DASC-21 assessment was conducted for all patients aged 75 years or older who were admitted to our hospital before the esophagectomy.

RESULTS

Postoperative pneumonia classified as Clavien-Dindo grade ≥ 2 occurred in 13 patients of all the 60 patients (21.7%). Receiver operating characteristic (ROC) curve analysis using postoperative pneumonia as the event showed that the optimal cutoff value of the DASC-21 score was 26 points. Fourteen elderly patients had DASC-21 high scores and 46 had low scores. Patients with high DASC-21 scores had significantly poorer performance status. The DASC-21 high score group had a higher incidence of postoperative pneumonia than the DASC-21 low score group (50.0% vs. 13.0%; p = 0.003). Furthermore, the DASC-21 high score group tended to have a higher transferring rate to other hospitals than the low score group (42.9% vs. 19.6%; p = 0.078). Older age (≥ 78 years old), poor performance status, comorbidity of diabetes mellitus, and DASC-21 high score were suggested as risk factors for postoperative pneumonia by univariate analysis.

CONCLUSIONS

The preoperative DASC-21 high score was significantly associated with the occurrence of postoperative pneumonia in elderly patients undergoing esophagectomy for esophageal cancer.