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Chylothorax as a Risk Factor for Thrombosis in Adults: A Proof-of-Concept Study

Sumedh S Hoskote1, Hemang Yadav1, Prashant Jagtap1

  • 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.

The Annals of Thoracic Surgery
|February 18, 2018
PubMed

Insights

Chylothorax after esophagogastrectomy increases vascular thrombosis risk in adults. This condition significantly raises the odds of deep vein thrombosis and pulmonary embolism, impacting patient mortality.

Area of Science:

  • Cardiovascular Medicine
  • Thoracic Surgery
  • Oncology

Background:

  • Postoperative chylothorax in children is linked to increased vascular thrombosis risk.
  • This association has not been previously described in adults undergoing Ivor-Lewis esophagogastrectomy.
  • Adult esophagogastrectomy patients have inherent thrombotic risk factors (malignancy, postoperative state).

Purpose of the Study:

  • To investigate the association between chylothorax and postoperative vascular thrombosis in adults.
  • To determine if chylothorax increases thrombotic risk in the context of esophagogastrectomy.

Main Methods:

  • Retrospective cohort study of adults undergoing Ivor-Lewis esophagogastrectomy (2006-2012).
  • Data collected: demographics, pleural fluid analysis, imaging, and thrombosis events within 30 days.
  • Multivariate logistic regression used to assess the impact of chylothorax on thrombosis incidence.

Main Results:

  • Chylothorax was identified in 5.9% of patients (36/608).
  • Vascular thrombosis incidence was 22.2% in chylothorax patients vs. 4.2% in others (p=0.001).
  • Chylothorax significantly increased odds of any vascular thrombosis (OR 5.46) and DVT/PE (OR 6.76).

Conclusions:

  • Chylothorax is a significant risk factor for vascular thrombosis in adults post-Ivor-Lewis esophagogastrectomy.
  • Vascular thrombosis in this cohort was associated with increased 90-day mortality.
  • Findings highlight the need for vigilance regarding thrombosis in esophagogastrectomy patients with chylothorax.
Abstract

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