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

Background: 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. Methods: 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. Results: AL occurred in 29 of 292 patients (9.9%). Patients with AL had a shorter QRS duration (median, 86 vs. 92 ms; Conclusion: 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.