title: Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer.
abstract: Morbidity and mortality after esophagectomy are often related to anastomotic leakage or pneumonia. This study aimed to assess the relationship of intraoperative and postoperative vital parameters with anastomotic leakage and pneumonia after esophagectomy. Consecutive patients who underwent transthoracic esophagectomy with cervical anastomosis for esophageal cancer from January 2012 to December 2013 were analyzed. Univariable and multivariable logistic regression analyses were used to determine potential associations of hemodynamic and respiratory parameters with anastomotic leakage or pneumonia. From a total of 82 included patients, 19 (23%) developed anastomotic leakage and 31 (38%) experienced pneumonia. The single independent factor associated with an increased risk of anastomotic leakage in multivariable analysis included a lower minimum intraoperative pH (OR 0.85, 95% CI 0.77-0.94). An increased risk of pneumonia was associated with a lower mean arterial pressure (MAP) in the first 12 hours after surgery (OR 0.93, 95% CI 0.86-0.99) and a higher maximum intraoperative pH (OR 1.14, 95% CI 1.02-1.27). Interestingly, no differences were noted for the MAP and inotrope requirement between patients with and without anastomotic leakage. A lower minimum intraoperative pH (below 7.25) is associated with an increased risk of anastomotic leakage after esophagectomy, whereas a lower postoperative average MAP (below 83 mmHg) and a higher intraoperative pH (above 7.34) increase the risk of postoperative pneumonia. These parameters indicate the importance of setting strict perioperative goals to be protected intensively.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands|Department of Radiation Oncology ,University Medical Center Utrecht, Utrecht, The Netherlands
authors.forename: L
authors.initials: L
authors.lastname: Goense
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands|Department of Radiation Oncology ,University Medical Center Utrecht, Utrecht, The Netherlands
authors.forename: P S N
authors.initials: PS
authors.lastname: van Rossum
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
authors.forename: M
authors.initials: M
authors.lastname: Tromp
authors.affiliation: Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: H C
authors.initials: HC
authors.lastname: Joore
authors.affiliation: Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: van Dijk
authors.affiliation: Department of Anesthesiology, University Medical Center Utrecht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Kroese
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
authors.forename: J P
authors.initials: JP
authors.lastname: Ruurda
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology*; D062186:Arterial Pressure; D016063:Blood Loss, Surgical; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007432:Intraoperative Period; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D011014:Pneumonia / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002316:Cardiotonic Agents
keywords: anastomotic leakage; esophageal cancer; esophageal surgery; pneumonia; postoperative care