Universität zu Köln

Bludau, M., Hoelscher, A. H., Bollschweiler, E., Leers, J. M., Gutschow, C. A., Brinkmann, S. and Schroeder, W. (2015). Preoperative airway colonization prior to transthoracic esophagectomy predicts postoperative pulmonary complications. Langenbecks Arch. Surg., 400 (6). S. 707 - 715. NEW YORK: SPRINGER. ISSN 1435-2451

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Abstract

Respiratory complications are responsible to a high degree for postoperative morbidity and mortality after Ivor-Lewis esophagectomy. The etiology of respiratory failure is known to be multifactorial with preoperative impaired lung function being the most important one. The aim of this study was to investigate the correlation between preoperative airway colonization (PAC) and postoperative respiratory complications. In this observational study, 64 patients with esophageal cancer were included. All patients underwent Ivor-Lewis esophagectomy with laparoscopic or open gastric mobilization. After induction of anesthesia and intubation with a double-lumen tube, bronchial exudate was collected by random endoluminal suction for further microbiological work-up. Length of postoperative mechanical ventilation (< 24 h, 24-72 h, > 72 h), re-intubation, and tracheostomy were recorded as primary and secondary study endpoints. In 13 of 64 study patients (20.3 %), pathological colonization of the bronchial airways could be proved prior to esophagectomy. Haemophilus species was the most frequently identified pathogen. PAC was associated with a longer history of smoking (p = 0.025), a lower preoperative forced expiratory volume (FEV1, p = 0.009) or vital capacity (VC, p = 0.038), a prolonged postoperative mechanical ventilation (p < 0.001), and a higher frequency of re-intubation (p < 0.001) and tracheostomy (p = 0.017). In the multivariate analysis, PAC was identified as an independent predictor of respiratory failure (hazard ratio 11.4, 95 % confidence interval 2.6-54, p = 0.002). Mortality in the PAC group was 30.8 % compared to 0 % in patients without PAC (p < 0.0001). PAC is a significant risk factor for postoperative respiratory failure. A routine bronchoscopy and bronchoalveolar lavage as part of preoperative management prior to esophagectomy need to be discussed.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bludau, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoelscher, A. H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bollschweiler, E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Leers, J. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gutschow, C. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Brinkmann, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schroeder, W. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-397414
DOI:	10.1007/s00423-015-1326-7
Journal or Publication Title:	Langenbecks Arch. Surg.
Volume:	400
Number:	6
Page Range:	S. 707 - 715
Date:	2015
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1435-2451
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language SURGICAL COMPLICATIONS; BACTERIAL-COLONIZATION; CANCER RESECTION; CARCINOMA; MORTALITY; SURVIVAL; METAANALYSIS; INFECTIONS; MANAGEMENT; MORBIDITY Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/39741