Determination of the optimal surgical procedure by identifying risk factors for pneumonia after transthoracic esophagectomy

Masato Hayashi, Hiroya Takeuchi, Rieko Nakamura, Koichi Suda, Norihito Wada, Hirofumi Kawakubo, Yuko Kitagawa

Research output: Contribution to journalArticle

Abstract

Background: Esophagectomy is associated with a high risk of postoperative complications, and the respiratory complications are the most common. Therefore, stratification of patients based on preoperative risk factors is essential. This study aimed to identify the risk of postoperative pneumonia (POP) based on the preoperative factors and determine the optimal perioperative surgical management strategy. Methods: This retrospective study involved 207 patients who underwent esophagectomy. The patients were divided into two groups, namely, with POP and without POP. To identify the risk factors for POP, the pre- and perioperative characteristics were analyzed. A receiver operating characteristics curve was used to determine a cutoff value of 2.40 L for the forced expiratory volume in 1 s (FEV1.0) and the cohort was divided into a high- and low-FEV1.0 group. A second analysis was then performed to determine the optimal surgical management for patients at a high risk for POP. Results: POP occurred in 45 (21.7%) patients. A multiple logistic regression analysis showed that FEV1.0 was significantly lower in the POP (+) group (P = 0.020); thus, a low FEV1.0 was found to be a risk factor for POP. Multiple logistic regression analysis showed that open thoracotomy was a significant risk factor for POP in low FEV1.0 patients (P = 0.013). Conclusions: A low FEV1.0 and an open thoracotomy are risk factors for POP. Therefore, patients with low FEV1.0 should be managed carefully and video-assisted thoracic surgery should be considered.

Original languageEnglish
JournalEsophagus
DOIs
Publication statusAccepted/In press - 2019 Jan 1

Fingerprint

Esophagectomy
Pneumonia
Thoracotomy
Logistic Models
Regression Analysis
Video-Assisted Thoracic Surgery
Forced Expiratory Volume
ROC Curve
Retrospective Studies

Keywords

  • Esophageal neoplasm
  • Esophagectomy
  • Pneumonia

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Determination of the optimal surgical procedure by identifying risk factors for pneumonia after transthoracic esophagectomy. / Hayashi, Masato; Takeuchi, Hiroya; Nakamura, Rieko; Suda, Koichi; Wada, Norihito; Kawakubo, Hirofumi; Kitagawa, Yuko.

In: Esophagus, 01.01.2019.

Research output: Contribution to journalArticle

@article{396c8b34c27d411dbc6d726c50bc7c5d,
title = "Determination of the optimal surgical procedure by identifying risk factors for pneumonia after transthoracic esophagectomy",
abstract = "Background: Esophagectomy is associated with a high risk of postoperative complications, and the respiratory complications are the most common. Therefore, stratification of patients based on preoperative risk factors is essential. This study aimed to identify the risk of postoperative pneumonia (POP) based on the preoperative factors and determine the optimal perioperative surgical management strategy. Methods: This retrospective study involved 207 patients who underwent esophagectomy. The patients were divided into two groups, namely, with POP and without POP. To identify the risk factors for POP, the pre- and perioperative characteristics were analyzed. A receiver operating characteristics curve was used to determine a cutoff value of 2.40 L for the forced expiratory volume in 1 s (FEV1.0) and the cohort was divided into a high- and low-FEV1.0 group. A second analysis was then performed to determine the optimal surgical management for patients at a high risk for POP. Results: POP occurred in 45 (21.7{\%}) patients. A multiple logistic regression analysis showed that FEV1.0 was significantly lower in the POP (+) group (P = 0.020); thus, a low FEV1.0 was found to be a risk factor for POP. Multiple logistic regression analysis showed that open thoracotomy was a significant risk factor for POP in low FEV1.0 patients (P = 0.013). Conclusions: A low FEV1.0 and an open thoracotomy are risk factors for POP. Therefore, patients with low FEV1.0 should be managed carefully and video-assisted thoracic surgery should be considered.",
keywords = "Esophageal neoplasm, Esophagectomy, Pneumonia",
author = "Masato Hayashi and Hiroya Takeuchi and Rieko Nakamura and Koichi Suda and Norihito Wada and Hirofumi Kawakubo and Yuko Kitagawa",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s10388-019-00692-x",
language = "English",
journal = "Esophagus",
issn = "1612-9059",
publisher = "Springer Japan",

}

TY - JOUR

T1 - Determination of the optimal surgical procedure by identifying risk factors for pneumonia after transthoracic esophagectomy

AU - Hayashi, Masato

AU - Takeuchi, Hiroya

AU - Nakamura, Rieko

AU - Suda, Koichi

AU - Wada, Norihito

AU - Kawakubo, Hirofumi

AU - Kitagawa, Yuko

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Esophagectomy is associated with a high risk of postoperative complications, and the respiratory complications are the most common. Therefore, stratification of patients based on preoperative risk factors is essential. This study aimed to identify the risk of postoperative pneumonia (POP) based on the preoperative factors and determine the optimal perioperative surgical management strategy. Methods: This retrospective study involved 207 patients who underwent esophagectomy. The patients were divided into two groups, namely, with POP and without POP. To identify the risk factors for POP, the pre- and perioperative characteristics were analyzed. A receiver operating characteristics curve was used to determine a cutoff value of 2.40 L for the forced expiratory volume in 1 s (FEV1.0) and the cohort was divided into a high- and low-FEV1.0 group. A second analysis was then performed to determine the optimal surgical management for patients at a high risk for POP. Results: POP occurred in 45 (21.7%) patients. A multiple logistic regression analysis showed that FEV1.0 was significantly lower in the POP (+) group (P = 0.020); thus, a low FEV1.0 was found to be a risk factor for POP. Multiple logistic regression analysis showed that open thoracotomy was a significant risk factor for POP in low FEV1.0 patients (P = 0.013). Conclusions: A low FEV1.0 and an open thoracotomy are risk factors for POP. Therefore, patients with low FEV1.0 should be managed carefully and video-assisted thoracic surgery should be considered.

AB - Background: Esophagectomy is associated with a high risk of postoperative complications, and the respiratory complications are the most common. Therefore, stratification of patients based on preoperative risk factors is essential. This study aimed to identify the risk of postoperative pneumonia (POP) based on the preoperative factors and determine the optimal perioperative surgical management strategy. Methods: This retrospective study involved 207 patients who underwent esophagectomy. The patients were divided into two groups, namely, with POP and without POP. To identify the risk factors for POP, the pre- and perioperative characteristics were analyzed. A receiver operating characteristics curve was used to determine a cutoff value of 2.40 L for the forced expiratory volume in 1 s (FEV1.0) and the cohort was divided into a high- and low-FEV1.0 group. A second analysis was then performed to determine the optimal surgical management for patients at a high risk for POP. Results: POP occurred in 45 (21.7%) patients. A multiple logistic regression analysis showed that FEV1.0 was significantly lower in the POP (+) group (P = 0.020); thus, a low FEV1.0 was found to be a risk factor for POP. Multiple logistic regression analysis showed that open thoracotomy was a significant risk factor for POP in low FEV1.0 patients (P = 0.013). Conclusions: A low FEV1.0 and an open thoracotomy are risk factors for POP. Therefore, patients with low FEV1.0 should be managed carefully and video-assisted thoracic surgery should be considered.

KW - Esophageal neoplasm

KW - Esophagectomy

KW - Pneumonia

UR - http://www.scopus.com/inward/record.url?scp=85073937651&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073937651&partnerID=8YFLogxK

U2 - 10.1007/s10388-019-00692-x

DO - 10.1007/s10388-019-00692-x

M3 - Article

C2 - 31501982

AN - SCOPUS:85073937651

JO - Esophagus

JF - Esophagus

SN - 1612-9059

ER -