scholarly journals Comparison of Chemical and Mechanical Prophylaxis of Venous Thromboembolism in Nonsurgical Mechanically Ventilated Patients

Thrombosis ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Dany Gaspard ◽  
Karen Vito ◽  
Christa Schorr ◽  
Krystal Hunter ◽  
David Gerber
Keyword(s):  
Mechanical Ventilation ◽  
Odds Ratio ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
University Hospital ◽  
Apache Ii Score ◽  
Thromboembolic Events ◽  
Mechanical Prophylaxis ◽  
Mechanically Ventilated ◽  
Nonsurgical Patients

Background. Thromboembolic events are major causes of morbidity, and prevention is important. We aimed to compare chemical prophylaxis (CP) and mechanical prophylaxis (MP) as methods of prevention in nonsurgical patients on mechanical ventilation. Methods. We performed a retrospective study of adult patients admitted to the Cooper University Hospital ICU between 2002 and 2010. Patients on one modality of prophylaxis throughout their stay were included. The CP group comprised 329 patients and the MP group 419 patients. The primary outcome was incidence of thromboembolic events. Results. Acuity measured by APACHE II score was comparable between the two groups (p=0.215). Univariate analysis showed 1 DVT/no PEs in the CP group and 12 DVTs/1 PE in the MP group (p=0.005). Overall mortality was 34.3% and 50.6%, respectively. ICU LOS was similar. Hospital LOS was shorter in the MP group. Multivariate analysis showed a significantly higher incidence of events in the MP prophylaxis group (odds ratio 9.9). After excluding patients admitted for bleeding in both groups, repeat analysis showed again increased events in the MP group (odds ratio 2.9) but this result did not reach statistical significance. Conclusion. Chemical methods for DVT/PE prophylaxis seem superior to mechanical prophylaxis in nonsurgical patients on mechanical ventilation and should be used when possible.

scholarly journals 832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S457-S457
Author(s):  
Henry Pablo Lopes Campos e Reis ◽  
Ana Beatriz Ferreira Rodrigues ◽  
Julio César Castro Silva ◽  
Lia Pinheiro de Lima ◽  
Talita Lima Quinaher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Univariate Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Multiresistant Pathogens ◽  
Gram Negative ◽  
Contact Isolation ◽  
Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p < 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p < 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

scholarly journals Impact of Permissive Hypoxia and Hyperoxia Avoidance on Clinical Outcomes in Septic Patients Receiving Mechanical Ventilation: A Retrospective Single-Center Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Kota Nishimoto ◽  
Takeshi Umegaki ◽  
Sayaka Ohira ◽  
Takehiro Soeda ◽  
Natsuki Anada ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
University Hospital ◽  
Icu Mortality ◽  
Respiratory Dysfunction ◽  
Mechanically Ventilated ◽  
Icu Stay ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Before And After ◽  
Clinical Records

Background. Septic patients often require mechanical ventilation due to respiratory dysfunction, and effective ventilatory strategies can improve survival. The effects of the combination of permissive hypoxia and hyperoxia avoidance for managing mechanically ventilated patients are unknown. This study examines these effects on outcomes in mechanically ventilated septic patients. Methods. In a retrospective before-and-after study, we examined adult septic patients (aged ≥18 years) requiring mechanical ventilation at a university hospital. On April 1, 2017, our mechanical ventilation policy changed from a conventional oxygenation target (SpO2: ≥96%) to more conservative targets with permissive hypoxia (SpO2: 88-92% or PaO2: 60 mmHg) and hyperoxia avoidance (reduced oxygenation for Pa O 2 > 110   mmHg ). Patients were divided into a prechange group (April 2015 to March 2017; n = 83 ) and a postchange group (April 2017 to March 2019; n = 130 ). Data were extracted from clinical records and insurance claims. Using a multiple logistic regression model, we examined the association of the postchange group (permissive hypoxia and hyperoxia avoidance) with intensive care unit (ICU) mortality after adjusting for variables such as Sequential Organ Failure Assessment (SOFA) score and PaO2/FiO2 ratios. Results. The postchange group did not have significantly lower adjusted ICU mortality (0.67, 0.33-1.43; P = 0.31 ) relative to the prechange group. However, there were significant intergroup differences in mechanical ventilation duration (prechange: 11.0 days, postchange: 7.0 days; P = 0.01 ) and ICU stay (prechange: 11.0 days, postchange: 9.0 days; P = 0.02 ). Conclusions. Permissive hypoxia and hyperoxia avoidance had no significant association with reduced ICU mortality in mechanically ventilated septic patients. However, this approach was significantly associated with shorter mechanical ventilation duration and ICU stay, which can improve patient turnover and ventilator access.

scholarly journals Ten-year experience with standardized non-operating room anesthesia with Sevoflurane for MRI in children affected by neuropsychiatric disorders

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Silvia Mongodi ◽  
Gaia Ottonello ◽  
Raffaelealdo Viggiano ◽  
Paola Borrelli ◽  
Simona Orcesi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Judgment ◽  
Statistical Significance ◽  
Neuromuscular Disorders ◽  
Univariate Analysis ◽  
Neuromuscular Diseases ◽  
Neuropsychiatric Disorders ◽  
University Hospital ◽  
Respiratory Complications ◽  
Asa Score

Abstract Background Children require anesthesia for MRI to maintain immobility and reduce discomfort; clear indications about the best anesthesiologic management are lacking and each center developed its own protocol. Moreover, children with neuropsychiatric disorders more likely require sedation and are described in literature as more prone to general and respiratory complications. Aim of this study was to analyze the applicability of a sevoflurane-based approach, to describe general and respiratory complications and to identify risk factors in a pediatric neuropsychiatric population. Methods Retrospective cohort study, university Hospital (January 2007–December 2016). All the 1469 anesthesiologic records of children addressed from Neuropsychiatric Unit to undergo MRI under general anesthesia were analyzed; 12 patients equal or older than 18-year-old were excluded. We identified post-hoc nine macro-categories: static encephalopathies, metabolic/evolutive encephalopathies, epileptic encephalopathies, neuromuscular diseases, autistic spectrum disorders, migraine, psychiatric disorders, intellectual disabilities, others. A logistic regression model for events with low frequency (Firth’s penalized likelihood approach) was carried out to identify the mutually adjusted effect among endpoints (complications) and the independent variables chosen on the basis of statistical significance (univariate analysis, p ≤ 0.05) and clinical judgment. Results Of 1457 anesthesiologic records (age 4.0 (IQR 2.0 to 7.0) year-old, males 891 (61.2%), weight 17.0 (IQR 12.0 to 24.9) kg), 18 were cancelled for high anesthesiologic risk, 50 were cooperative, 1389 were anesthetized. A sevoflurane-based anesthesia was feasible in 92.3%; these patients required significantly less mechanical ventilation (8.6 vs. 16.2%; p = 0.012). Complications’ rate was low (6.2%; 3.1% respiratory). The risk for general complications increases with ASA score > 1 (OR 2.22, 95 CI% 1.30 to 3.77, p = 0.003), male sex (OR 1.73, 95% CI 1.07 to 2.81, p = 0.025), multi-drug anesthesia (OR 2.98, 95 CI% 1.26 to 7.06, p = 0.013). For respiratory complications, it increases with ASA score > 1 (OR 2.34, 95 CI% 1.19 to 4.73, p = 0.017), autumn-winter (OR 2.01, 95 CI% 1.06 to 3.78, p = 0.030), neuromuscular disorders (OR 3.18, 95 CI% 1.20 to 8.41, p = 0.020). We had no major complications compromising patients’ outcome or requiring admission to ICU. Conclusions Sevoflurane anesthesia is feasible and safe for children affected by neuropsychiatric disorders undergoing MRI. Specific risk factors for general and respiratory complications should be considered.

Oral Presentation VI

2016 ◽  
Vol 8 (1) ◽  
pp. 34-39
Author(s):  
Woo Young Kim ◽  
Jeonghun Lee ◽  
Euy-Young Soh
Keyword(s):  
Braf Mutation ◽  
Odds Ratio ◽  
Lymphovascular Invasion ◽  
Univariate Analysis ◽  
Male Gender ◽  
University Hospital ◽  
Capsular Invasion ◽  
Papillary Thyroid ◽  
Factors Associated ◽  
Clinicopathologic Factors

ABSTRACT BACKGROUND AND AIMS Papillary thyroid cancer (PTC) is the most frequent subtype among thyroid cancers. Lymph node (LN) metastases are frequent in PTC and the incidence is 60% on average. Recent studies have shown that there has been an increase in the mortality or recurrence with LN metastases and that more than 5 metastatic LNs are clinically important. Therefore, we investigated clinicopathologic factors associated with clinically important LN metastases. METHODS From January 2010 to October 2013, we retrospectively enrolled 2,628 PTC patients who underwent thyroidectomy at Ajou University Hospital. Among 1,425 patients with LN metastasis, 325 had ≥ 5 LN metastases. RESULTS In univariate analysis, young age (< 45 year), male gender, capsular invasion, multiplicity, tumor size, and lymphovascular invasion (p < 0.001) were statistically associated with both LN metastasis and ≥ 5 LN metastases. However, Braking Action Fair (BRAF) mutation was not important to predict LN metastasis (p > 0.05). In multivariate analysis, lymphovascular invasion was the most important factor (odds ratio: 4.7, 4.0) among other clinicopathologic factors (odds ratio:< 2.1). CONCLUSION Braking Action Fair (BRAF) mutation was not useful to predict the LN metastasis. However, lymphovascular invasion was the most important factor to predict more than five cervical LN metastasis which is very important clinically.

scholarly journals The Extent of Ventilator-Induced Lung Injury in Mice Partly Depends on Duration of Mechanical Ventilation

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Maria A. Hegeman ◽  
Sabrine N. T. Hemmes ◽  
Maria T. Kuipers ◽  
Lieuwe D. J. Bos ◽  
Geartsje Jongsma ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Capillary Permeability ◽  
Statistical Significance ◽  
Lung Compliance ◽  
Alveolar Cell ◽  
Mechanically Ventilated ◽  
Ventilator Induced Lung Injury ◽  
Cell Counts ◽  
Alveolar Capillary

Background. Mechanical ventilation (MV) has the potential to initiate ventilator-induced lung injury (VILI). The pathogenesis of VILI has been primarily studied in animal models using more or less injurious ventilator settings. However, we speculate that duration of MV also influences severity and character of VILI.Methods. Sixty-four healthy C57Bl/6 mice were mechanically ventilated for 5 or 12 hours, using lower tidal volumes with positive end-expiratory pressure (PEEP) or higher tidal volumes without PEEP. Fifteen nonventilated mice served as controls.Results. All animals remained hemodynamically stable and survived MV protocols. In both MV groups, PaO2to FiO2ratios were lower and alveolar cell counts were higher after 12 hours of MV compared to 5 hours. Alveolar-capillary permeability was increased after 12 hours compared to 5 hours, although differences did not reach statistical significance. Lung levels of inflammatory mediators did not further increase over time. Only in mice ventilated with increased strain, lung compliance declined and wet to dry ratio increased after 12 hours of MV compared to 5 hours.Conclusions. Deleterious effects of MV are partly dependent on its duration. Even lower tidal volumes with PEEP may initiate aspects of VILI after 12 hours of MV.

scholarly journals Nosocomial infections in the Intesive care unit, University hospital for infectious and tropical diseases, Belgrade, Serbia

2014 ◽  
Vol 71 (2) ◽  
pp. 131-136
Author(s):  
Ivana Milosevic ◽  
Milos Korac ◽  
Goran Stevanovic ◽  
Djordje Jevtovic ◽  
Branko Milosevic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Urinary Tract ◽  
Nosocomial Infections ◽  
Statistical Significance ◽  
University Hospital ◽  
Tropical Diseases ◽  
Electronic Data Base ◽  
Tract Infections

Bacground/Aim. Nosocomial infections (NIs) are an important cause of morbidity, mortality and prolonged hospitalizations. Fifty percent of NIs have been reported in Intensive Care Units. The aim of this study was to determine the frequency and type of NIs among critically ill patients treated in the University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, as well as risk factors for acquiring them. Methods. This prospective cohort study included 52 patients treated in the Intensive Care Unit from January to June 2004. The diagnosis of NI was established according to the Centers for Disease Control and Prevention (CDC) definition, based on clinical presentation, radiological and microbiological findings, etc. Statistical data processing was done by using the electronic data base organized in SPSS for Windows version 10.0. The level of statistical significance was defined as p < 0. 05. Results. NIs were found in 33 (63.4%) of 52 inpatients. Urinary tract infections (UTIs), pneumonia, and soft tissue infections, the most common nosocomial infections in our setting, were recorded in 41.0%, 25.6%, and 23.1%, of patients, respectively. Several factors contributed to a high incidence of these infections: chronic comorbidities (p < 0.01), the presence of indwelling devices such as urinary tract catheters (p < 0.01), endotracheal tubes (p < 0.05) along with mechanical ventilation (p < 0.05). Conclusion. The majority of patients with NIs had chronic underlying comorbidities. All the patients with UTIs had urinary catheters. The most important risk factors for the development of nosocomial pneumonias were endotracheal intubation and mechanical ventilation. The patients with pneumonia had the highest mortality.

scholarly journals Pain Assessment Is Associated with Decreased Duration of Mechanical Ventilation in the Intensive Care Unit

2009 ◽  
Vol 111 (6) ◽  
pp. 1308-1316 ◽  
Author(s):  
Jean-Francois Payen ◽  
Jean-Luc Bosson ◽  
Gérald Chanques ◽  
Jean Mantz ◽  
José Labarere ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Pain Assessment ◽  
Odds Ratio ◽  
Ventilator Support ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Score Analysis ◽  
Adjusted Score ◽  
Ventilated Patients

Background Critically ill patients frequently experience pain, but assessment rates remain below 40% in mechanically ventilated patients. Whether pain assessment affects patient outcomes is largely unknown. Methods As part of a prospective cohort study of mechanically ventilated patients who received analgesia on day 2 of their stay in the intensive care unit (ICU), the investigators performed propensity-adjusted score analysis to compare the duration of ventilator support and duration of ICU stay between 513 patients who were assessed for pain and 631 patients who were not assessed for pain. Results Patients assessed for pain on day 2 were more likely to receive sedation level assessment, nonopioids, and dedicated analgesia during painful procedures than patients whose pain was not assessed. They also received fewer hypnotics and lower daily doses of midazolam. Patients with pain assessment had a shorter duration of mechanical ventilation (8 vs. 11 days; P &lt; 0.01) and a reduced duration of stay in the ICU (13 vs. 18 days; P &lt; 0.01). In propensity-adjusted score analysis, pain assessment was associated with increased odds of weaning from the ventilator (odds ratio, 1.40; 95% confidence interval, 1.00-1.98) and of discharge from the ICU (odds ratio, 1.43; 95% confidence interval, 1.02-2.00). Conclusions Pain assessment in mechanically ventilated patients is independently associated with a reduction in the duration of ventilator support and of duration of ICU stay. This might be related to higher concomitant rates of sedation assessments and a restricted use of hypnotic drugs when pain is assessed.

scholarly journals Closed-Loop Versus Conventional Mechanical Ventilation in COVID-19 ARDS

2021 ◽  
pp. 088506662110241
Author(s):  
Pedro David Wendel Garcia ◽  
Daniel Andrea Hofmaenner ◽  
Silvio D. Brugger ◽  
Claudio T. Acevedo ◽  
Jan Bartussek ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Odds Ratio ◽  
Closed Loop ◽  
Conventional Mechanical Ventilation ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Mechanically Ventilated ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Background: Lung-protective ventilation is key in bridging patients suffering from COVID-19 acute respiratory distress syndrome (ARDS) to recovery. However, resource and personnel limitations during pandemics complicate the implementation of lung-protective protocols. Automated ventilation modes may prove decisive in these settings enabling higher degrees of lung-protective ventilation than conventional modes. Method: Prospective study at a Swiss university hospital. Critically ill, mechanically ventilated COVID-19 ARDS patients were allocated, by study-blinded coordinating staff, to either closed-loop or conventional mechanical ventilation, based on mechanical ventilator availability. Primary outcome was the overall achieved percentage of lung-protective ventilation in closed-loop versus conventional mechanical ventilation, assessed minute-by-minute, during the initial 7 days and overall mechanical ventilation time. Lung-protective ventilation was defined as the combined target of tidal volume <8 ml per kg of ideal body weight, dynamic driving pressure <15 cmH2O, peak pressure <30 cmH2O, peripheral oxygen saturation ≥88% and dynamic mechanical power <17 J/min. Results: Forty COVID-19 ARDS patients, accounting for 1,048,630 minutes (728 days) of cumulative mechanical ventilation, allocated to either closed-loop (n = 23) or conventional ventilation (n = 17), presenting with a median paO2/ FiO2 ratio of 92 [72-147] mmHg and a static compliance of 18 [11-25] ml/cmH2O, were mechanically ventilated for 11 [4-25] days and had a 28-day mortality rate of 20%. During the initial 7 days of mechanical ventilation, patients in the closed-loop group were ventilated lung-protectively for 65% of the time versus 38% in the conventional group (Odds Ratio, 1.79; 95% CI, 1.76-1.82; P < 0.001) and for 45% versus 33% of overall mechanical ventilation time (Odds Ratio, 1.22; 95% CI, 1.21-1.23; P < 0.001). Conclusion: Among critically ill, mechanically ventilated COVID-19 ARDS patients during an early highpoint of the pandemic, mechanical ventilation using a closed-loop mode was associated with a higher degree of lung-protective ventilation than was conventional mechanical ventilation.

scholarly journals Association between ROTEM Hypercoagulable Profile and Outcome in a Cohort of Severely Ill COVID-19 Patients Under Mechanical Ventilation

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 12-13
Author(s):  
Damian Ratano ◽  
Caragata Rebecca ◽  
Eddy Fan ◽  
Ewan C Goligher ◽  
Rita Selby ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Research Funding ◽  
Alpha Angle ◽  
Anticoagulation Therapy ◽  
Renal Outcome ◽  
Published Data ◽  
Fisher Exact Test ◽  
Thromboembolic Events ◽  
Mechanically Ventilated ◽  
Increased Risk

Introduction: Recently published data show that COVID-19 is characterized by a hypercoagulable ROTEM profile and decreased fibrinolysis. Multiple reports suggest that severe COVID-19 infection is associated with an increased thromboembolic risk. There are limited data associating a hypercoagulable ROTEM profile and outcomes in the literature. A hypercoagulable ROTEM profile could help identify patients at risk of worse outcome and help target a study population for enhanced anticoagulation therapy or other COVID-19 therapy. Objectives: To determine if early hypercoagulability on ROTEM is associated with a higher risk of thromboembolic complications or worse outcome, in a population of mechanically ventilated COVID-19 patients transferred to a tertiary ARDS/ECMO referral center. Methods: All COVID-19 patients receiving mechanical ventilation at our center between April 3 and June 15, 2020 were assessed with ROTEM. Testing performed included at least ExTEM and FibTEM. Patients were classified as hypercoagulable (HC) or not (nHC) using the following criteria from ROTEM: ExTEM clot formation time (E_CFT)&lt; 40 sec, alpha (∝) angle &gt;79° and, either ExTEM or FibTEM maximum clot firmness (E_MCF or F_MCF) &gt;70mm or &gt;24mm, respectively. Outcomes, assessed at discharge from our ICU, included thromboembolic events (TE: composite of deep vein thrombosis, pulmonary embolism and ischemic stroke), acute kidney injury (AKI: AKIN stage &gt;2 with or without dialysis), duration of mechanical ventilation, requirement for ECMO, and death. Difference between groups was determined using the chi-square or Fisher-exact test for categorical data and a t-test for continuous variables respectively, using p&lt;0.05 as significant. Results: Of 59 patients included, 31 were hypercoagulable (HC) on admission. Mean (SD) age was 52 (14), and SOFA score on admission was high 15 (2). The severity of disease was similar in both groups especially for the cardiac and respiratory SOFA components (Table 1). The composite outcome of TE was not different between the groups (HC 9/31, nHC 6/28, p=0.7). The composite renal outcome was not different (HC 18/31 vs nHC 16/28). Mortality rate (29%, HC 9 vs nHC 8), and the duration of ventilation in survivors (HC 22 vs nHC 22 days) were similar in both groups. Requirement for ECMO support was similar (HC 8 vs nHC 12, p= 0.27). Patients were tested with daily viscoelastic tests and, neither fibrinolysis nor DIC were documented. All patients received TE prophylaxis and 34 received therapeutic intravenous heparin for ECMO (n=20) or TE treatment (n=14). Initial ROTEM were conducted on therapeutic heparin in 22 cases (12 HC, 10 nHC). Conclusion: Our data suggest that in a population of mechanically ventilated patients with severe COVID-19, an early hypercoagulable profile on ROTEM was not associated with an increased risk of thromboembolic events, AKI, prolonged ventilation, ECMO or death during their ICU stay. Disclosures Karkouti: Octapharma: Research Funding; Canadian blood services: Research Funding.

O144 CALCIFICATION IN THE DESCENDING AORTA PREDICTS POSTOPERATIVE LEAKAGE OF INTRA-THORACIC ANASTOMOSIS AFTER OPEN ESOPHAGECTOMY FOR CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
M Ukkonen ◽  
E Wirta ◽  
J Khan ◽  
T Tyrväinen ◽  
A Kechagias
Keyword(s):  
Anastomotic Leakage ◽  
Thoracic Aorta ◽  
Abdominal Aorta ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Preoperative Staging ◽  
University Hospital ◽  
Descending Thoracic Aorta ◽  
Open Esophagectomy ◽  
Esophagectomy For Cancer

Abstract Aim Postoperative anastomotic leakage is a major complication in the surgery of the esophagus. In this study, we aim to examine whether calcifications of the aortic segments can predict anastomotic leakage after open esophagectomy for cancer with intra-thoracic anastomosis of a gastric conduit. Background and methods All patients with esophageal cancer who underwent elective esophagectomy with an intra-thoracic anastomosis at Tampere University Hospital between 2007-2018 were evaluated. Preoperative data were associated to outcome. These included demographic, anamnestic, clinical, laboratory, and radiologic data. Preoperative staging thoraco-abdominal CT-scans were re-evaluated to document the presence of calcifications in the various aortic segments. Results A total of 97 patients (median age 64 (43-78) years, 20% female) were analysed, with anastomotic leakage occurring in 22 patients (23%). Median time from surgery to leakage was 10 (1-32) days, and follow-up time 28 (1-143) months. From all the factors that were evaluated in the univariate analysis, only the presence of calcification in the descending thoracic aorta was associated with a higher risk of anastomotic leakage (11% vs. 33%, HR 4.571; 95% CI 1.40-15.0; p=0.011). There was a trend for anastomotic leakage in the presence of calcification in the suprarenal abdominal aorta (13% vs. 29%, p=0.057). A higher leakage rate was documented when a calcification was present in the infrarenal abdominal aorta (8.3% vs. 25%, p=0.205), and in the ascending thoracic aorta (22% vs. 30%, p=0.559), without reaching statistical significance. Conclusion The presence of a calcification in the descending thoracic aorta is associated with higher risk of anastomotic leakage after open esophagectomy for cancer.

Sign in / Sign up

Export Citation Format

Share Document