I have major problems with this study, stemming from inherent limitations in the Nationwide Inpatient Sample. It’s an administrative database set up chiefly to track costs, utilization, and length of stay. It contains no information at all on key clinical outcomes such as 30- and 90-day mortality, discharge disposition, or 30-day readmission rates.
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In addition, the accuracy of the quoted in-hospital morbidity rates is suspect, probably because data entry isn’t performed by trained researchers. For example, the 8% incidence of renal failure in esophagectomy patients cited in this study sounds too high to be right.
And there’s another major problem with this database: The superior outcomes reported for transthoracic esophagectomy recipients in this study fly in the face of earlier, well-conducted meta-analyses that reached the opposite conclusion. The most likely explanation for the discordant findings lies in the fact that the NIS doesn’t show whether a transthoracic esophagectomy was performed via open thoracotomy in the old-school manner or with an intrathoracic anastomosis created using contemporary minimally invasive techniques which, while complex, have been associated with better outcomes.
Dr. James D. Luketich is professor of surgery and chief of the Heart, Lung, and Esophageal Surgery Institute at the University of Pittsburgh. He was the designated discussant of the study at the meeting.
AT THE ASA ANNUAL MEETING
