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Preventing Pneumonia in High-risk Patients After Esophageal Cancer Surgery: Mini-tracheostomy and
Mitsuo Nishiyama1, Shigeru Takeda1, Yusaku Watanabe1
1Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Background/Aim:
We evaluated the usefulness of prophylactic mini-tracheostomy (PMT) and perioperative administration of tazobactam/piperacillin (TAZ/PIPC) in high-risk patients after esophagectomy.
Patients And Methods:
We retrospectively studied 89 consecutive high-risk patients who underwent esophagectomy for esophageal cancer between January 2013 and December 2021. We defined patients with two or more of the following factors as high risk: age ≥70 years, performance status ≥1, respiratory dysfunction, liver dysfunction, cardiac dysfunction, renal dysfunction, diabetes mellitus, albumin <3.5 g/dl, and Brinkman index >600. Standard management was administered to the first 50 patients (standard group). PMT and TAZ/PIPC were administered to the next 39 patients (combination group). Patient characteristics and short-term outcomes were compared before and after propensity-score matching.
Results:
Before propensity-score matching, 24-hour urine creatinine clearance, retrosternal route, 3-field lymph node dissection, and open abdominal approach were more common, postoperative pneumonia (13% vs. 36%, p=0.045) and complications of grade ≥3b (2.6% vs. 22%, p=0.01) were less frequent, and the postoperative hospital stay was shorter (median: 23 vs. 28 days, p=0.022) in the combination group than in the standard group. In propensity-score matching, patient characteristics, except for 24-h creatinine clearance and reconstructive route, were matched for 23 paired patients. Postoperative pneumonia (8.7% vs. 39%, p=0.035) and complications of grade ≥3b (0% vs. 26%, p=0.022) were less frequent and postoperative hospital stay was shorter (median: 22 vs. 25 days, p=0.021) in the combination group than in the standard group.
Conclusion:
PMT with TAZ/PIPC can potentially prevent postoperative pneumonia in high-risk patients after esophagectomy.
Insights
Prophylactic mini-tracheostomy (PMT) combined with perioperative tazobactam/piperacillin (TAZ/PIPC) reduced postoperative pneumonia and severe complications in high-risk esophagectomy patients. This combination therapy offers a promising strategy for improving outcomes in this vulnerable population.
Area of Science:
- Surgical Oncology
- Critical Care Medicine
- Pharmacology
Background:
- Esophagectomy carries significant risks, particularly for high-risk patients.
- Postoperative complications, such as pneumonia, are common and associated with increased morbidity and mortality.
- Identifying effective strategies to mitigate these risks is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of prophylactic mini-tracheostomy (PMT) and perioperative tazobactam/piperacillin (TAZ/PIPC) administration.
- To assess the impact of this combined approach on postoperative outcomes in high-risk patients undergoing esophagectomy.
Main Methods:
- Retrospective study of 89 high-risk esophagectomy patients (January 2013 - December 2021).
- High-risk criteria included age ≥70, performance status ≥1, and various organ dysfunctions.
- Comparison between a standard management group (n=50) and a combination group (PMT + TAZ/PIPC, n=39) using propensity-score matching.
Main Results:
- The combination group showed significantly lower rates of postoperative pneumonia (8.7% vs. 39%) and grade ≥3b complications (0% vs. 26%) after propensity-score matching.
- Postoperative hospital stay was also shorter in the combination group (median 22 vs. 25 days).
- These benefits were observed despite similar patient characteristics between matched groups, except for creatinine clearance and reconstructive route.
Conclusions:
- Prophylactic mini-tracheostomy (PMT) combined with perioperative tazobactam/piperacillin (TAZ/PIPC) is a potentially effective strategy.
- This approach can significantly reduce the incidence of postoperative pneumonia and severe complications in high-risk patients after esophagectomy.
- Further prospective studies are warranted to confirm these findings.
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