Association between underweight status and chylothorax after esophagectomy for esophageal cancer: A propensity score–matched analysisCentral MessagePerspective

• Published in: JTCVS open 2024-02, Vol.17, p.322-335
• Main Authors: Victoria Yin, BA, Alexander T. Kim, BA, Sean C. Wightman, MD, Takashi Harano, MD, Scott M. Atay, MD, Anthony W. Kim, MD
• Format: Article
• Language: English
• Subjects: body mass index; chylothorax; esophagectomy; risk factors; underweight
• ISSN: 2666-2736

Objective: To use a nationwide database of hospitalizations to investigate underweight status as a risk factor for postesophagectomy complications. Methods: We identified all patients who underwent esophagectomy with a diagnosis of esophageal cancer and known body mass index in the 2018-2020 Nationwide Readmissions Database. All hospital visits for esophagectomy and within 30 days of initial discharge were analyzed for postoperative complications, including chylothorax. Patients who were underweight were propensity score matched with patients who were not. Multivariable logistic regression was performed to identify complications that were significantly associated with underweight status. Results: There were 1877 patients with esophageal cancer meeting inclusion criteria. Following propensity score matching, 433 patients who were underweight were matched to 433 patients who were not. In the multivariable model of the matched sample, which adjusted for age, sex, Charlson Comorbidity Index, history of chemotherapy or radiation therapy, and preoperative surgical feeding access, patients who were underweight were estimated to have 2.06 times the odds for chylothorax (95% confidence interval [CI], 1.07-4.25, P = .035). Underweight status was also significantly associated with acute bleed (odds ratio [OR], 1.52; 95% CI, 1.12-2.05, P = .007), pneumothorax (OR, 2.33; 95% CI, 1.19-4.85; P = .017), pneumonia (OR, 2.30; 95% CI, 1.53-3.50, P