Discharge readiness and nutritional-inflammatory status as discharge-day markers of 30-day unplanned healthcare utilization after direct minimally invasive esophagectomy for esophageal squamous cell carcinoma

Recovery after minimally invasive esophagectomy (MIE) for esophageal squamous cell carcinoma (ESCC) extends beyond discharge. We examined whether discharge-day readiness and nutritional-inflammatory status were associated with 30-day unplanned healthcare utilization (UHU). This single-center retrospective cohort included consecutive patients with biopsy-proven cT1bN0M0/cStage I or cT2N0M0/cStage II ESCC who underwent direct MIE without preoperative antitumor therapy from January 1, 2023 to December 31, 2025. Discharge readiness was obtained from routine nursing records using the Chinese Readiness for Hospital Discharge Scale (RHDS). Nutritional indicators included prognostic nutritional index (PNI) and Nutritional Risk Screening 2002 (NRS 2002). The primary outcome was any unplanned outpatient visit, emergency department visit, or readmission within 30 days after discharge. Multivariable association analyses and exploratory sequential risk-identification analyses were performed. Among 389 patients, 116 (29.8%) experienced 30-day UHU. UHU rates decreased across low-, middle-, and high-readiness groups (66.7%, 31.3%, and 10.2%). Pathological upstaging occurred in 110 patients (28.3%), including occult pN-positive disease in 83 (21.3%). In the fully adjusted model, higher RHDS (OR per 10-point increase 0.60, 95% CI 0.48–0.77), higher PNI (OR per 5-point increase 0.64, 95% CI 0.42–0.95), and higher NRS 2002 score (OR per 1-point increase 1.66, 95% CI 1.33–2.08) were associated with UHU. Results were similar when clinical stage was replaced with pathological stage and after excluding 18 patients with anastomotic leakage diagnosed before discharge or within 30 days after discharge. The optimism-corrected AUC increased from 0.741 to 0.831 across the sequential models. Lower discharge readiness and poorer nutritional status at discharge were associated with higher 30-day UHU after direct MIE for ESCC. The RHDS-UHU association was concentrated primarily in outpatient-oriented utilization. These discharge-day measures should be interpreted as markers of transitional-care needs rather than causal determinants or a clinically deployable prediction tool. Prospective external validation is required.