Shorter perioperative QRS duration and a leftward frontal-plane QRS axis are associated with anastomotic leakage after esophagectomy: a hypothesis-generating study.

Authors

Mengke Ma, Youjia Zhu, Handan Lin, Weizhuo Liu, Wendi Fei, Haotian Jiang, Bin He

Published in

Frontiers in medicine. Volume 13. Pages 1942699. Epub Sep 29, 2026.

Abstract

Anastomotic leakage (AL) after esophagectomy is a serious complication for which early physiological signals remain limited. We conducted a hypothesis-generating analysis of whether routinely reported electrocardiographic QRS measurements were associated with AL during the perioperative period.
This single-center retrospective cohort included 292 of 1,441 patients undergoing esophagectomy who had an index 12-lead electrocardiogram (ECG) from day -1 through postoperative day 1. ECG acquisition followed routine clinical practice rather than a study protocol. QRS duration and frontal-plane QRS axis were retained after descriptive screening of the continuous ECG measurements available in the analytic extract. They were entered into a two-variable logistic model, followed by a sensitivity model additionally adjusting for seven clinical characteristics. Timing-stratified associations and same-cohort model discrimination were also examined.
AL occurred in 29 of 292 patients (9.9%). Patients with AL had a shorter QRS duration (median, 86 vs. 92 ms; P = 0.016) and a more leftward QRS axis (4 degrees vs. 27 degrees; P = 0.006). In the two-variable model, standardized odds ratios (ORs) were 0.378 (95% CI, 0.178-0.801) for QRS duration and 0.501 (0.323-0.779) for QRS axis. In the sensitivity model, the corresponding ORs were 0.359 (0.170-0.761) and 0.486 (0.299-0.789). The QRS-axis association was stronger preoperatively, whereas the QRS-duration association was stronger from day 0 through postoperative day 1. Median repeated-cross-validation AUCs were 0.702 for the ECG model, 0.559 for the clinical reference model, and 0.690 for the combined model; bootstrap confidence intervals for both AUC differences versus the clinical reference included zero.
Shorter QRS duration and a more leftward frontal-plane QRS axis were associated with AL after esophagectomy. These QRS measurements are potential perioperative signals that require prospective validation rather than established predictors.

PMID:
42871121
Bibliographic data and abstract were imported from PubMed on 14 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.