Risk Stratification of Postoperative Pneumonia in Patients Undergoing Subtotal Esophagectomy for Esophageal Cancer

Abstract

Background/Aim: Despite recent progress in surgical techniques and perioperative management, postesophagectomy pneumonia remains the most common complication. Thus, it is important to identify the risk factors of postoperative pneumonia and to improve perioperative management. This study aimed to clarify risk factors for postoperative pneumonia and subsequently stratify the risk of pneumonia. Patients and Methods: A total of 154 patients who underwent subtotal esophagectomy were divided into two groups: patients without pneumonia and those with pneumonia. Their backgrounds and operative outcomes were compared. Furthermore, risk factors of postoperative pneumonia were evaluated using a logistic regression model. Results: Postoperative pneumonia developed in 18.8% (n=29) of the study cohort. In the multivariate analysis, the independent risk factors for postoperative pneumonia were forced expiratory volume at 1 s (FEV1) <1.98 l [p=0.011; odds ratio (OR)=3.960; 95% confidence interval (CI)=1.380-11.400], thoracotomy (p=0.043; OR=3.110; 95%CI=1.030-9.320), operative blood loss ≥390 ml (p=0.013; OR=3.900; 95%CI=1.340-11.400), and recurrent laryngeal nerve palsy (RLNP) (p=0.014; OR=3.740; 95%CI=1.310-10.700). Patients were also stratified into the following four groups as per the number of significant risk factors: the incidence of pneumonia in patients with no risk factor, one risk factor, two risk factors, three risk factors were 7.0% (5/71), 13.7% (7/51), 43.5% (10/23), and 77.7% (7/9), respectively. Conclusion: FEV1 <1.98 l, thoracotomy, operative blood loss ≥390 ml, and RLNP were independent risk factors of postoperative pneumonia. Additionally, patients could be stratified into four groups according to the incidence of pneumonia.