Incidence and Risk Factors for Respiratory Complications in Patients Undergoing Esophagectomy for Malignancy: A NSQIP Analysis

Daniela Molena, Benedetto Mungo, Miloslawa Stem, Anne O. Lidor

Research output: Contribution to journalArticle

Abstract

Respiratory complications are the most frequent adverse events in patients undergoing esophagectomy for cancer, and their occurrence may negatively affect postoperative recovery and outcomes. We queried the American College of Surgeons National Surgical Quality Improvement Program dataset to study the rate and influence of pneumonia, unplanned intubation, and ventilator dependency >48 hours on the early outcomes after esophagectomy and risk factors for their development. We included adult patients with an esophageal or gastric cancer diagnosis who were treated with esophagectomy between 2005 and 2012 and grouped them into 2 categories with respect to development of respiratory complications. Early surgical outcomes (including 30-day mortality, overall morbidity, return to operating room, and length of hospital stay) were compared. Risk factors associated with respiratory complications after esophagectomy were assessed using modified Poisson regression. A total of 2945 patients were identified and respiratory complications were observed in 687 (23.3%) of them. We observed a significant decrease in respiratory complication rates after esophagectomy throughout the studied years. Patients who developed respiratory complications were older and had more comorbidities and longer operative time. These patients also had statistically significantly higher rates of 30-day mortality and overall morbidity and were more likely to return to the operating room and to stay in the hospital longer. On multivariable analysis, numerous factors, including advanced age, smoking, alcohol use, dyspnea, history of chronic obstructive pulmonary disease, and prolonged operative time, were found to be risk factors for developing respiratory complications. As the development of respiratory complications leads to worse early surgical outcomes after esophagectomy, efforts should be made to prevent their occurrence by identifying patients with significant risk factors.

Original languageEnglish (US)
Pages (from-to)287-294
Number of pages8
JournalSeminars in Thoracic and Cardiovascular Surgery
Volume26
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Esophagectomy
Incidence
Length of Stay
Neoplasms
Operating Rooms
Operative Time
Morbidity
Mortality
Mechanical Ventilators
Esophageal Neoplasms
Respiratory Rate
Quality Improvement
Intubation
Dyspnea
Chronic Obstructive Pulmonary Disease
Stomach Neoplasms
Comorbidity
Pneumonia
Smoking
Alcohols

Keywords

  • Esophageal cancer
  • Esophagectomy
  • Respiratory complications
  • Surgical outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Incidence and Risk Factors for Respiratory Complications in Patients Undergoing Esophagectomy for Malignancy : A NSQIP Analysis. / Molena, Daniela; Mungo, Benedetto; Stem, Miloslawa; Lidor, Anne O.

In: Seminars in Thoracic and Cardiovascular Surgery, Vol. 26, No. 4, 2014, p. 287-294.

Research output: Contribution to journalArticle

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