Predicting pulmonary complications after esophagectomy: A retrospective cohort study.

Abstract

Background: Pulmonary complications are the main cause of postoperative mortality in patients undergoing esophagectomy. The aim of this study was to identify the risk factors associated with major pulmonary complications in these patients.

Methods: This was a retrospective cohort study of patients who underwent esophagectomy between January 2004 and December 2014. We retrieved data on patient- and surgery-related variables and the postoperative complications from medical records, including age, gender, physical status as per the American Society of Anesthesiologists' (ASA) classification, smoking status, hemoglobin, albumin, creatinine, forced expiratory volume in the first second (FEV1), neoadjuvant therapy, type of surgery (transthoracic vs. others), thoracic approach (minimally invasive vs. open), lymphadenectomy type (three field or abdominal vs. two field), intraoperative blood loss, operative time, and use of epidural analgesia. We classified pulmonary complications using the Clavien-Dindo system. Multivariable logistic regression analysis was used to derive the odds ratios (OR) with 95% confidence intervals (CI) to identify significant risk factors for major pulmonary complications (Clavien-Dindo grade 3 or more).

Results: We obtained relevant data on 1189 patients operated during the study period. Increasing age (OR 1.03, 95% CI 1.01; 1.04; P < 0.01), FEV1% less than 70% (OR 1.71, 95% CI 1.03; 2.83; P = 0.04), three-field lymphadenectomy (OR 2.12, 95% CI 1.50; 3.01; P < 0.01), and use of analgesia techniques other than epidural (OR 1.51, 95% CI 1.07; 2.13; P = 0.02) were independent predictors of major pulmonary complications.

Conclusions: The recognition of factors associated with increased risk of pulmonary complications in patients undergoing esophagectomy could help in risk stratification, preoperative optimization, and early detection of complications.