An esophagectomy surgical Apgar score-based nomogram-a risk-based postoperative triage system: a phase II randomised trial

Xiaohan Chen; Yong Xi; Chengbin Lin; Hongyan Yu; Jae Y Kim; Jon O Wee; Xianneng He; Jiajun Gao; Weiyu Shen

doi:10.21037/jtd-24-451

An esophagectomy surgical Apgar score-based nomogram-a risk-based postoperative triage system: a phase II randomised trial

J Thorac Dis. 2024 Apr 30;16(4):2550-2562. doi: 10.21037/jtd-24-451. Epub 2024 Apr 26.

Authors

Xiaohan Chen¹, Yong Xi¹, Chengbin Lin¹, Hongyan Yu¹, Jae Y Kim², Jon O Wee³, Xianneng He¹, Jiajun Gao¹, Weiyu Shen¹

Affiliations

¹ Department of Thoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China.
² Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
³ Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Abstract

Background: The esophagectomy surgical Apgar score (eSAS) has been found to be a predictor of postoperative complications in esophagectomy. In our previous study, we built a graphic nomogram based on eSAS and demonstrated that it can effectively predict the risk of major morbidity after esophagectomy. In this study, we aimed to assess the benefits of using an eSAS-based nomogram model as a postoperative risk-based triage system for patients undergoing esophagectomy.

Methods: We enrolled 119 patients diagnosed with esophageal carcinoma and randomly assigned them to a nomogram group (NG) or control group (CG) from January 2019 to December 2020. Patients in the NG were assigned to a low-risk group and high-risk group based on the nomogram. Patients in the high-risk group were admitted to the intensive care unit (ICU) after esophagectomy. Risk estimation in the CG patients was based on the surgeon's clinical experience. Thirty-day major complications, postoperative hospital stay, hospital costs, and quality of life (QOL) during the follow-up were compared between the two groups.

Results: Baseline clinicopathological characteristics were comparable between the NG (n=58) and CG (n=61). All patients underwent esophagectomy. Postoperative complications were significantly higher in the CG (30, 49.2%) than in the NG (14, 24.1%) (P=0.008), with pneumonia being the most common (CG: 23, 37.7%; NG: 12, 20.7%; P=0.042). There was no significant difference in anastomotic leakage (NG: 1, 1.7%; CG: 6, 9.8%; P=0.12). Postoperative median hospital stay was shorter in the NG (14 days) than in the CG (16 days) (P=0.041). Hospital costs (NG: ¥60,045.1; CG: ¥63,961.5; P=0.21) and postoperative QOL did not differ significantly between groups.

Conclusions: An eSAS-based nomogram as a triage system can reduce the overall occurrence of postoperative complications and shorten postoperative hospital stay without increasing hospital costs.

Trial registration: Chinese Clinical Trial Registry ChiCTR1900021636.

Keywords: Esophagectomy surgical Apgar score-based nomogram (eSAS-based nomogram); esophagectomy; intensive care unit admission (ICU admission); postoperative complications; postoperative triage.