LAUSR

J Thorac Dis 2020;12(9):4608-4611 | http://dx.doi.org/10.21037/jtd-20-1670 Esophageal resection for malignant neoplasms is a procedure associated with high morbidity—in fact, morbidity rates have been reported to be as high as 59% (1,2). Common early postoperative complications include cardiac and pulmonary complications (arrhythmias, pneumonitis, etc.), anastomotic complications (leak and stricture), vocal cord paralysis, conduit necrosis or failure, and chyle leak (2). Thromboembolic events, infection, and wound-related morbidities further complicate the postoperative course. The median hospital stay after an uncomplicated esophageal resection at high-volume centers is around 8 days (3). Early postoperative complications prolong the hospital stay and increase the incidence of unplanned readmissions after a patient has been discharged (3). Hospital stay and readmission rates are considered potential markers of the success of the esophageal resection. It may seem intuitive that a potential reverse relationship exists between the hospital stay and readmission rates, where too much emphasis on reducing hospital stay may increase the likelihood of readmission, as some have reported (4). Several other published studies, however, dispute this finding by reporting a higher readmission rate in patients who had a previous longer hospital stay, which reflects the higher morbidity rate in this subgroup of patients (5). The recent study “Incidence and risk factors of readmission after esophagectomy for esophageal cancer” by Park and colleagues at Yonsei University College of Medicine, South Korea reported a readmission rate of 13.4% within 30 days of discharge after esophageal resection (6). In their analysis, they found postoperative anastomotic leakage and wound-related problems to be significant risk factors predictive of readmission. They also reported a significant financial burden associated with readmission. Anastomotic strictures requiring balloon dilatation were reported in more than 30% of patients, and were the most common cause of readmission in their study, with other common causes being wound problems (18%), pneumonia (15%), and poor oral intake (10%). Additionally, bowel dysfunction (including delayed gastric emptying and prolonged ileus) were present in approximately 13% of cases. Despite 21% of patients developing vocal cord palsy postoperatively, this was not a significant factor for readmission. Furthermore, 38% of patients who were readmitted required intervention for their associated complication(s). In this study, Park et al. emphasized the importance of a postoperative intensive patient education program to prevent common complications, such as aspiration due to vocal cord palsy and gastric fullness due to delayed gastric emptying. The mean hospital stay in their study (25.6 days) was longer than the average length of stay reported by most major centers (12–13 days) (3,4,6). Several authors have reported on factors associated with readmission after esophageal resection. Table 1 shows the reported factors associated with readmission in major Editorial