Predictors of readmission after esophagectomy for esophageal cancer: a systematic review and meta-analysis.

INTRODUCTION

Esophageal cancer represents a major global health challenge. Multimodality treatment, involving esophagectomy with chemotherapy, radiotherapy, or immunotherapy, remains the standard of care for locally advanced esophageal cancers.

OBJECTIVES

Unplanned hospital readmission has emerged as a key indicator of surgical quality and long-term patient outcomes after esophageal cancer surgery. This meta-analysis aims to provide a comprehensive review of predictors of unplanned readmission following esophagectomy.

METHODS

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A literature search for studies reporting readmission following esophagectomy up to November 2024 was conducted for PubMed and Embase. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported for the risk factors in question. Random-effects meta-analysis models were applied accordingly.

RESULTS

A total of 43 studies with 164 948 participants were included, with a pooled readmission rate of 16.4%. Comorbidities, particularly diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease, were associated with increased risk of readmission. A higher risk of readmission was also observed among women [OR 1.12 (95% CI 1.02, 1.23) P = 0.02]. Both higher American Society of Anesthesiologists (ASA) (III/IV) and longer length of index stay (>10 days) were important indicators of higher readmission rates [OR 2.27 (1.05, 4.89), P < 0.004] and [OR 1.35 (1.14, 1.61), P < 0.0007]. In contrast, neoadjuvant therapy was a protective factor for readmission [0.74 (95% CI 0.59, 0.92) P = 0.008]. Postoperative complications, especially anastomotic leak, wound-related, pulmonary, and thromboembolic events, were associated with readmission. Readmission was not significantly associated with mortality [OR 1.65 (95% CI 0.82, 3.33), P = 0.16].

CONCLUSION

This review provides a comprehensive overview of readmission after esophageal cancer surgery, a major indicator fof quality care. Our findings identified several potential risk factors of readmission following esophagectomy. These included comorbidities, ASA III/IV status, postoperative complications, and prolonged hospital stay. Neoadjuvant therapy may have potential benefits on unplanned readmission. By identifying modifiable risk factors, future optimization of health outcomes and preventive measures can be achieved.