Ventilatory and intensive care requirements following oesophageal resection

The aim of this study was to analyse the results of early postoperative extubation following oesophagectomy.

All patients who had undergone oesophageal resection between 1994 and 2001 were identified from a prospectively collected database. Their records were then reviewed in order to analyse morbidity and mortality along with intensive care unit (ICU) and ventilatory requirements. All patients were extubated immediately following surgery and monitored on a surgical high dependency unit (HDU).

A total of 98 resections were undertaken (76 men; mean age, 64.3 years; range, 40-80 years). Surgical procedures were Ivor-Lewis (71), left thoraco-abdominal (15) and transhiatal (12) oesophagectomies. Overall, 8 patients died and 13 patients had anastomotic leaks. Sixteen patients required ventilation and admission to ICU, of whom 5 died. Three patients died on HDU following an elective decision not to transfer to ICU. Reasons for ventilation and ICU admission were anastomotic leaks (6), respiratory problems (6), left ventricular failure (1), cardiac arrest (1), small bowel herniation through the hiatus (1) and ischaemic stomach requiring revision of anastomosis (1). No patient required ventilation and admission to ICU within 48 h of original surgery.

Patients undergoing oesophageal resection can be safely managed on a surgical HDU without routine postoperative ventilation. Although ventilation and ICU will be required in a significant number due to postoperative complications, this is unlikely to occur in the first 48 h. The requirement for an ICU bed to be available on the day of surgery should, therefore, no longer be considered necessary. This has important implications for the scheduling of elective oesophageal surgery.