P1.238. Postoperative Outcomes in Patients After Prolonged Intensive Care Unit Stay After Esophagectomy: A Prospective Single-Center Cohort Study

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background Prolonged intensive care unit stay (≥7 days) is common after esophagectomy. Although prolonged ICU stay after major surgery is associated with poor short- and long-term outcomes, this remains unexamined in esophageal cancer surgery. This study examined the impact of prolonged ICU stay on survival and clinical outcomes in patients who underwent an esophagectomy. Methods This single-centre cohort study analysed prospectively maintained data on patients who underwent an esophagectomy between January 2010 and December 2024. Patients with a prolonged ICU stay of ≥7 days (including non-consecutive admissions) were assigned to the exposure group, those with ICU stays of <7 days were defined as the control group. Overall survival was analysed using Kaplan-Meier curves, and comparisons were made using the log-rank test. Univariable and multivariable Cox regression analyses were performed. Logistic and linear regression were used to examine clinical outcomes. Results A total of 875 patients underwent an esophagectomy between 2010 and 2024. 125 patients (14.3%) had a prolonged stay in the ICU postoperatively. Compared to patients without a prolonged ICU stay, these patients were significantly older, had more comorbidities, differed in tumor type and had a higher clinical node stage (N+). Furthermore, they experienced more postoperative complications. Patients with a prolonged ICU stay had significantly worse overall survival outcomes compared with those with shorter ICU stay (5-year overall survival, 22% vs 39.5%, (p<0.001)). In multivariable Cox regression, prolonged ICU stay remained independently associated with higher mortality (Hazard ratio [HR], 1.68, 95% CI 1.33-2.14, p<0.001). Prolonged ICU stay was also associated with increased in-hospital mortality (OR 26.8, 95% CI 10.5-68.0) and longer total hospital length of stay (median 38 days vs 12 days; p<0.001), whereas readmission and reoperation rates did not differ significantly between the two groups. Conclusion Prolonged ICU stay (≥7 days) after esophagectomy is independently associated with worse short- and long-term outcomes, including reduced overall survival, higher in-hospital mortality, and longer hospital length of stay. Recognizing and systematically addressing the needs of these high-risk patients may provide an opportunity to improve outcomes in this vulnerable population.