Prediction of risk factors associated with readmission after robotic esophagectomy.

328 Background: Approximately, 20,640 new esophageal cancers (EC) will be diagnosed in 2022 and this will result in 16,410 deaths. Surgical resection remains the only potentially curative option, however significant morbidity and mortality ensues. Robotic approaches to esophageal resection have decreased overall length of hospitalizations. However, readmissions rates continue to be a significant concern. We sought to evaluate factors predicting readmission after robotic assisted trans-thoracic esophagectomy (RATE). Methods: Utilizing a prospectively maintained esophageal database, we identified patients with EC who underwent RATE between 2009-2022. We then stratified by readmissions, length of hospitalization and post-operative complications. Pre-operative, peri-operative and post-operative risk factors were identified as predictors of readmissions. Baseline univariate comparisons were made for continuous variables using both the Mann-Whitney U and Kruskal Wallis tests. Pearson’s Chi-square test was used to compare categorical variables. Multivariate analysis was performed identifying predictors of readmission. Results: We identified 312 patients, who underwent RATE with a median age of 68 (38-91). There were 29 (9.3%) patients who underwent readmission. There were no differences in age (p=0.10), gender (p=0.39) BMI (p=0.22), or histology (p=0.35) between patients that were readmitted and those that were not. ASA scores were higher in those that were readmitted p=0.01 compared to those who were not. The median length of hospitalization (LOH) was 8 (7-11) and did not differ between those that were re-admitted and those that were not p=0.79. The most common reasons for re-admissions were pulmonary 16 (5.1%), anastomotic leak 6 (1.9%), soft tissue infection 2 (0.6%), nutrition 3 (1%) and gastrointestinal 2 (0.6%). Pre-operative risk factors predictive of readmissions included cardiac disease p=0.002 and diabetes p=0.04. Operative risk factors: estimated blood loss p=0.9 and operative time p=0.24 did not predict readmission. Post-operative complications occurred in 93 (29.8%) of patients. Any post-operative complication p=0.32 did not predict re-admission with the exception of anastomotic leak p=0.04. Additionally, length of ICU did not differ between those re-admitted and those who were not, p=0.96. Ninety-day mortality was significantly higher in those that were re-admitted, 13.8% vs 4% in those that were not re-admitted, p=0.001. Multivariate analysis revealed that cardiac disease, diabetes, ASA score, and anastomotic leak were all predictors of readmission. Conclusions: Readmission after RATE remains low despite decreased LOH. Patients that are readmitted will have a significantly higher risk of mortality at 90-days. Pre-operative, peri-operative and post-operative factors can be used to accurately predict risk for readmission after robotic esophagectomy.