Table 1.
Baseline characteristics and crude outcomes categorized by hospitals’ early extubation proportion.
| Variables | Very low <11% 122 hospitals (n=9407) | Low 11–37% 161 hospitals (n=9395) | Medium 38–83% 164 hospitals (n=9621) | High ≥84% 98 hospitals (n=9560) | P |
|---|---|---|---|---|---|
| Patient demographics | |||||
| Male sex | 7820 (83) | 7835 (83) | 8052 (84) | 7916 (83) | 0.40 |
| Age, year | |||||
| 18–59 | 1656 (18) | 1767 (19) | 1747 (18) | 1825 (19) | 0.092 |
| 60–64 | 1647 (18) | 1654 (18) | 1693 (18) | 1654 (17) | |
| 65–69 | 2311 (25) | 2139 (23) | 2334 (24) | 2205 (23) | |
| 70–74 | 2063 (22) | 2063 (22) | 2080 (22) | 2057 (22) | |
| ≥75 | 1730 (18) | 1772 (19) | 1767 (18) | 1819 (19) | |
| BMI, kg/m2 | |||||
| <16.0 | 372 (4.0) | 356 (3.8) | 354 (3.7) | 341 (3.6) | 0.018 |
| 16.0–18.4 | 1504 (16) | 1475 (16) | 1402 (15) | 1359 (14) | |
| 18.5–22.9 | 4813 (51) | 4841 (52) | 5018 (52) | 4998 (52) | |
| 23.0–27.4 | 2388 (25) | 2414 (26) | 2482 (26) | 2541 (27) | |
| ≥27.5 | 330 (3.5) | 309 (3.3) | 365 (3.8) | 321 (3.4) | |
| Smoking index, pack-years | |||||
| 0–5 | 2658 (28) | 2763 (29) | 2807 (29) | 2608 (27) | <0.001 |
| 6–20 | 1018 (11) | 991 (11) | 1035 (11) | 1244 (13) | |
| 21–40 | 2132 (23) | 2049 (22) | 2144 (22) | 2352 (25) | |
| ≥41 | 2554 (27) | 2270 (24) | 2434 (25) | 2657 (28) | |
| Missing | 1045 (11) | 1322 (14) | 1201 (12) | 699 (7.3) | |
| Barthel index <95 | 668 (7.1) | 232 (2.5) | 236 (2.5) | 201 (2.1) | <0.001 |
| Charlson comorbidity index | |||||
| 2 | 7226 (77) | 7175 (76) | 7537 (78) | 7883 (82) | <0.001 |
| 3–4 | 1328 (14) | 1477 (16) | 1508 (16) | 1023 (11) | |
| ≥5 | 853 (9.1) | 743 (7.9) | 576 (6.0) | 654 (6.8) | |
| Hypertension | 1954 (21) | 2153 (23) | 2120 (22) | 2409 (25) | <0.001 |
| Diabetes mellitus | 1216 (13) | 1264 (13) | 1327 (14) | 1020 (11) | <0.001 |
| COPD | 174 (1.9) | 284 (3.0) | 243 (2.5) | 136 (1.4) | <0.001 |
| Renal failure | 91 (1.0) | 99 (1.1) | 86 (0.9) | 65 (0.7) | 0.042 |
| Liver disease | 471 (5.0) | 524 (5.6) | 517 (5.4) | 389 (4.1) | <0.001 |
| Corticosteroid use before surgery | 78 (0.8) | 86 (0.9) | 82 (0.9) | 48 (0.5) | 0.005 |
| Clinical stage | |||||
| 0–I | 2895 (31) | 2861 (30) | 2979 (31) | 2785 (29) | <0.001 |
| II–IV | 6406 (68) | 6065 (65) | 6385 (66) | 6657 (70) | |
| X or missing | 106 (1.1) | 469 (5.0) | 257 (2.7) | 118 (1.2) | |
| Treatments | |||||
| Preoperative treatment | |||||
| Chemotherapy | 4683 (50) | 4015 (43) | 4270 (44) | 4932 (52) | <0.001 |
| Radiotherapy | 751 (8.0) | 542 (5.8) | 642 (6.7) | 748 (7.8) | <0.001 |
| Three-field lymph node dissection | 7806 (83) | 7353 (78) | 7675 (80) | 7770 (81) | <0.001 |
| Thoracic approach | |||||
| Unspecified (to March 2014) | 3566 (38) | 3944 (42) | 3675 (38) | 3443 (36) | <0.001 |
| Open | 2394 (29) | 2564 (27) | 2572 (27) | 2670 (28) | |
| Minimally invasive | 3147 (33) | 2887 (31) | 3374 (35) | 3447 (36) | |
| Intestine reconstruction | 230 (2.4) | 229 (2.4) | 263 (2.7) | 226 (2.4) | 0.37 |
| Vessel reconstruction | 43 (0.5) | 25 (0.3) | 21 (0.2) | 10 (0.1) | <0.001 |
| Epidural anesthesia | 7450 (79) | 7200 (77) | 7778 (81) | 8399 (88) | <0.001 |
| Prophylactic corticosteroids | 6853 (73) | 5715 (61) | 5255 (55) | 5967 (62) | <0.001 |
| Duration of anesthesia, min | |||||
| <488 | 1567 (17) | 2130 (23) | 2046 (21) | 3713 (39) | <0.001 |
| 488–584 | 2371 (25) | 2327 (25) | 2319 (24) | 2441 (26) | |
| 585–689 | 2615 (28) | 2470 (26) | 2502 (26) | 1947 (20) | |
| ≥690 | 2854 (30) | 2468 (26) | 2754 (29) | 1459 (15) | |
| Hospital characteristics | |||||
| Teaching hospital | 5980 (64) | 6067 (65) | 6385 (66) | 4750 (50) | <0.001 |
| Hospital volume, cases/year | |||||
| <7.3 | 1652 (18) | 2793 (30) | 2773 (29) | 1265 (13) | <0.001 |
| 7.3–19.7 | 2558 (27) | 2748 (29) | 2482 (26) | 2092 (22) | |
| 19.8–42.8 | 2716 (29) | 2788 (30) | 1796 (19) | 2315 (24) | |
| ≥42.9 | 2481 (26) | 1066 (11) | 2570 (27) | 3888 (41) | |
| Fiscal year | |||||
| 2010–2011 | 1211 (13) | 1687 (18) | 1453 (15) | 1449 (15) | <0.001 |
| 2012–2013 | 2355 (25) | 2257 (24) | 2222 (23) | 1994 (21) | |
| 2014–2015 | 2505 (27) | 2319 (25) | 2430 (25) | 2579 (27) | |
| 2016–2018 | 3336 (35) | 3132 (33) | 3516 (37) | 3538 (37) | |
| Crude outcomes | |||||
| Respiratory complications | 3237 (34) | 3050 (32) | 2495 (26) | 1488 (16) | <0.001 |
| Mechanical ventilation >2 days | 1924 (20) | 1914 (20) | 1264 (13) | 647 (6.8) | <0.001 |
| Mechanical ventilation >7 days | 899 (9.6) | 950 (10) | 729 (7.6) | 466 (4.9) | <0.001 |
| Reintubation | 908 (9.7) | 1072 (11) | 687 (7.1) | 459 (4.8) | <0.001 |
| Noninvasive ventilation | 83 (0.9) | 158 (1.7) | 74 (0.8) | 49 (0.5) | <0.001 |
| High-flow nasal cannula (from April 2016)* | 253/3336 (7.6) | 153/3132 (4.9) | 128/3516 (3.6) | 97/3538 (2.7) | <0.001 |
| Anastomotic leakage | 1392 (15) | 1623 (17) | 1240 (13) | 1176 (12) | <0.001 |
| Other major complications | 1018 (11) | 1131 (12) | 1033 (11) | 850 (8.9) | <0.001 |
| In-hospital mortality | 248 (2.6) | 281 (3.0) | 221 (2.3) | 204 (2.1) | 0.001 |
| Vasopressor use† | 5256 (56) | 5152 (55) | 4185 (44) | 3429 (36) | <0.001 |
| Postoperative length of stay, days | 27 (19–43) | 26 (19–45) | 26 (18–41) | 21 (16–33) | <0.001 |
| Total hospitalization costs, US$ | 31 412 (27 551–39 187) | 31 415 (27 219–40 157) | 29 826 (25 934–37 809) | 27 464 (24 506–32 789) | <0.001 |
Data are presented as n (%) or median (interquartile range).
*
Patients who underwent esophagectomy before April 2016 (n=24 461) were excluded from the outcome analysis.
†
Vasopressor use was defined as the use of noradrenaline, dopamine, or dobutamine on the day of, or the day after surgery.
COPD, chronic obstructive pulmonary disease.