Table 5.
Pooled outcomes according to the SEAL score
| SEAL score (predicted risk of 90-day mortality) | ||||
|---|---|---|---|---|
| Mild (<5%) | Moderate (≥5–<15%) | Severe (≥15–<25%) | Critical (≥25%) | |
| Example | Patient diagnosed on surgical ward, on a water diet and with a small defect and viable conduit. No organ failure or intrathoracic fluid collections | Patient presenting with intrathoracic collections or a large defect, with leucocytosis and tachypnoea or hypotension | Patient diagnosed on POD 3 in ICU with single organ failure, together with intrathoracic fluid collections or a large anastomotic defect | Complex presentation, patient with multiple organ failure and combination of intrathoracic fluid collections, large defect and/or conduit necrosis |
| % of patients, range * | 25.4 (21–30) | 51.2 (47–56) | 13.4 (12–15) | 10.1 (9–11) |
| Predicted mortality risk (%), range*† | 3.6 (3–4) | 8.8 (8–9) | 19.2 (19–20) | 36.6 (36–38) |
| 90-day mortality (%), range *† | 3.0 (2–4) | 8.0 (7–9) | 23.5 (18–27) | 36.6 (33–40) |
| 30-day mortality (%), range*† | 0.5 (0–1) | 3.3 (3–4) | 8.3 (6–11) | 22.1 (20–24) |
| 180-day mortality (%), range*† | 5.8 (4–7) | 12.3 (11–13) | 28.5 (23–33) | 43.6 (39–47) |
| In-hospital mortality (%), range*† | 1.8 (1–3) | 7.2 (6–8) | 21.3 (16–25) | 37.6 (35–41) |
| Duration of hospital stay (mean, days), range*† | 27 (26–29) | 39 (38–41) | 52 (48–57) | 50 (48–53) |
| Duration of ICU stay (mean, days), range*† | 5 (4–5) | 11 (10–12) | 22 (19–24) | 28 (27–30) |
| Leak healing time (mean, days), range*† | 30 (28–32) | 35 (33–36) | 41 (36–48) | 43 (39–51) |
| CCI score (mean), range*† | 34 (33–35) | 46 (45–47) | 64 (62–66) | 77 (75–79) |
| ECCG classification (%), range*† | ||||
| Type I | 42.8 (40–48) | 28.1 (25–31) | 12.5 (9–16) | 3.5 (1–7) |
| Type II | 36.8 (34–40) | 38.7 (36–42) | 33.9 (28–38) | 30.4 (25–34) |
| Type III | 20.5 (17–23) | 33.2 (31–36) | 53.6 (50–60) | 66.1 (62–72) |
*
Range across imputations. SEAL, Severity of oEsophageal Anastomotic Leak; ICU, intensive care unit; POD, postoperative day; CCI, Comprehensive Complication index; ECCG, Esophagectomy Complications Consensus Group. †P < 0.010 (χ2 test for ordinal outcomes, 1-way ANOVA for continuous outcomes).