Postoperative mortality (30-day and in-hospital) remains high after esophagectomy. Age, Charlson score, and hospital volume were identified as independent predictors of postoperative mortality. A simple risk prediction model that uses preoperative clinical data accurately predicted patient postoperative mortality for this SEER-Medicare population.

Main Outcome Measures: The rate of surgical intervention was compared across varying patient characteristics, including age, race, comorbidity score, sex, tumor stage, and socioeconomic region. Survival was compared between patients who received surgery and those who did not using Kaplan-Meier curves, the logrank test, and Cox proportional hazards regression. Statistical analysis was performed using the 2 test and multiple logistic regression. Results: The overall rate of surgical intervention in this cohort was 34.1%. In all, 36.8% of white patients underwent surgical treatment of their disease, whereas only 19.2% of nonwhite patients did. Patients residing in areas with high poverty rates were 27% less likely to have surgery. Older age and higher comorbidity scores were also associated with lower rates of surgery. Patients who received surgical treatment for their disease experienced significantly longer survival than did patients who did not undergo surgical resection. Conclusions: There seems to be significant underuse of esophagectomy as treatment for potentially resectable stage I, II, and III esophageal cancers across all patient groups. In nonwhite and low socioeconomic patient cohorts, the underuse is even more pronounced.

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Purpose Sepsis can lead to poor outcomes when treatment is delayed or inadequate. The purpose of this study was to evaluate outcomes after initiation of a hospital-wide sepsis alert program. Materials and methods Retrospective review of patients ≥18 years treated for sepsis. Results There were 3917 sepsis admissions: 1929 admissions before, and 1988 in the after phase. Mean age (57.3 vs. 57.1, p = 0.94) and Charlson Comorbidity Scores (2.52 vs. 2.47, p = 0.35) were similar between groups. Multivariable analyses identified significant reductions in the after phase for odds of death (OR 0.62, 95% CI 0.39–0.99, p = 0.046), mean intensive care unit LOS (2.12 days before, 95%CI 1.97, 2.34; 1.95 days after, 95%CI 1.75, 2.06; p < 0.001), mean overall hospital LOS (11.7 days before, 95% CI 10.9, 12.7 days; 9.9 days after, 95% CI 9.3, 10.6 days, p < 0.001), odds of mechanical ventilation use (OR 0.62, 95% CI 0.39, 0.99, p = 0.007), and total charges with a savings of $7159 per sepsis admission (p = 0.036). There was no reduction in vasopressor use (OR 0.89, 95% CI 0.75, 0.1.06, p = 0.18). Conclusion A hospital-wide program utilizing electronic recognition and RRT intervention resulted in improved outcomes in patients with sepsis.