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Perioperative risk analysis for acute respiratory distress syndrome after elective oesophagectomy
Author(s) -
Paul Diana J.,
Jamieson Glyn G.,
Watson David I.,
Devitt Peter G.,
Game Philip A.
Publication year - 2011
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2010.05598.x
Subject(s) - medicine , perioperative , odds ratio , ards , esophagectomy , incidence (geometry) , respiratory distress , surgery , cancer , esophageal cancer , lung , physics , optics
Background: Acute respiratory distress syndrome (ARDS) is a major contributor to respiratory morbidity and mortality after oesophagectomy. Several pre‐, intra‐ and post‐operative factors are thought to predispose to its development in the post‐oesophagectomy period. The aim of this study was to determine factors predisposing to ARDS in the post‐oesophagectomy period. Methods: A total of 112 patients who underwent elective oesophagectomy for oesophageal cancer (gastro‐oesophageal adenocarcinoma and high‐grade dysplasia, 93; oesophageal squamous cell carcinoma, 16; oesophageal oat cell tumour, 1; oesophageal anaplastic carcinoma, 1; oesophageal colloid carcinoma, 1) between 1 January 2003 and 31 December 2006 formed the study group in this retrospective study. The pre‐, intra and post‐operative data for these patients (male : female = 89:23, mean age 60.8 years) were collected from an oesophagectomy database and hospital medical records. Results: The incidence of ARDS was 13%. The in‐hospital mortality among ARDS cases was 20% and 1‐year mortality was 40%. Various factors such as preoperative chronic respiratory disease ( P ‐value = 0.000, odds ratio = 17.76), smoking pack‐years ( P ‐value = 0.045, odds ratio = 1.02), abnormal preoperative forced expiratory volume in 1 s ( P ‐value = 0.009, odds ratio = 7.97), high percentage of oxygen in inspired air ( P ‐value = 0.041, odds ratio = 1.24) and use of perioperative inotropes ( P ‐value = 0.021, odds ratio = 4.26) were associated with ARDS. Conclusions: Preoperative physiological status as indicated by a preoperative history of chronic respiratory disease and preoperative pulmonary function influenced the post‐operative outcome in our patients. The use of perioperative inotropes suggests perioperative cardiorespiratory instability, and could also predispose to the development of ARDS in the post‐operative period.