Alcohol abuse among adults with esophageal cancer and impact on outcomes of esophagectomy.

Abstract

e16056 Background: Recent reports from the American Cancer Society confirmed a rising incidence, mortality rate, and burden of esophageal cancer in the United States. Although alcohol abuse is one of the key risk factors, its impact on the outcomes of esophageal cancer undergoing esophagectomy has not been well reported in the literature. Methods: This study relied on National Inpatient Sample records to evaluate patients with esophageal cancer admissions. We first estimated the prevalence of alcohol abuse among them(per 100,000 cases of esophageal cancer). Then, all patients undergoing esophagectomy were retained, and we explored the impact of alcohol abuse on their in-hospital outcomes. Results: Between 2016 and 2022, there were 283895 all-cause admissions involving esophageal cancer patients, with 19745(7.0%) having a history of alcohol abuse. The highest rate was noted in 2021(7.3%), with the lowest in 2016(6.5%). There were 21770 procedures of esophagectomy conducted during those calendar years, with 5.1%(1115) having a history of alcohol abuse. Those with alcohol abuse were younger (mean age of 61.37 vs. 64.31 years, p < 0.01), had a higher mean Charlson Comorbidity Index(CCI) score(4.02 vs. 3.65, p < 0.01), and contained more males (86.1% vs. 79.9%, p < 0.01), than the non-alcohol abuse group. Our cohort with alcohol abuse faced various in-hospital complications such as pneumonia (aOR 2.052, 95% CI 1.779-2.366, p < 0.01), postprocedural pneumothorax(aOR 1.776,95% CI1.370-2.302, p < 0.01), and sepsis(aOR 1.624, 95% CI 1.351-1.952, p < 0.01). Although bleeding events between the two groups were not different(aOR 1.516, 95% CI 0.938-2.449, p = 0.09), the need for blood transfusion was higher among the alcohol abuse patients (aOR 1.944, 95% CI 1.604-2.356, p < 0.01). Alcohol abuse also involved a heavier burden on healthcare, as the patients stayed on average for 16.66 days (vs. 13.45 days, p < 0.01) and also had higher odds of all-cause death (aOR 1.864, 95% CI 1.449-2.397, p < 0.01). Conclusions: Our findings confirm that esophageal cancer patients with alcohol abuse who were undergoing esophagectomy were younger, with a higher mortality burden, and experienced more complications. Such results underscore the need to address alcohol consumption as a modifiable risk factor and to evaluate adequate preoperative screening and targeted measures that can help improve surgical outcomes.