Duration of one-lung ventilation as a risk factor for postoperative pulmonary complications after McKeown esophagectomy

Author:

Lai Guozhong1,Guo Na23,Jiang Yu2,Lai Jielan2,Li Yi2,Lai Renchun2ORCID

Affiliation:

1. Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China

2. Department of Anesthesiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China

3. Guangdong Esophageal Cancer Institute, Guangzhou, China

Abstract

Objective:To assess whether the duration of one-lung ventilation (OLV) affects postoperative pulmonary complications after McKeown esophagectomy for esophageal cancer.Methods:A retrospective analysis of data stored in a database for esophageal cancer was carried out to identify predictors of postoperative pulmonary complications in patients undergoing McKeown esophagectomy at Sun Yat-sen University Cancer Center between 2010 and 2012.Results:Patients in the OLV ⩾150 minutes group had a higher incidence of postoperative pulmonary complications than those in the OLV <150 minutes group (18.0% vs 7.3%, p < 0.001). Among them, the number of patients who developed pneumonia and atelectasis was also significantly higher (9.0% vs 4.1% [ p = 0.031] and 8.7% vs 3.7% [ p = 0.018] for the OLV ⩾150 minutes group vs OLV <150 minutes group, respectively). OLV ⩾150 minutes was associated with a prolonged hospital stay (24.2 ± 9.7 vs 21.5 ± 9.2 days, p = 0.001). Multivariate analysis revealed that history of diabetes (odds ratio [OR], 3.56; 95% confidence interval [CI], 1.65–7.68; p = 0.001), chronic obstructive pulmonary disease (OR, 10.65; 95% CI, 5.65–20.08; p < 0.001), and OLV ⩾150 minutes (OR, 3.80; 95% CI, 1.97–7.31; p < 0.001) were independent predictors of postoperative pulmonary complications.Conclusion:Long duration of OLV appears to be an important risk factor for postoperative pulmonary complications after McKeown esophagectomy. OLV <150 minutes appears to be the better approach for thoracic surgery. Lung protective measures should be taken when prolonged OLV is anticipated.

Funder

Guangdong Esophageal Cancer Institute Science and Technology Program

Publisher

SAGE Publications

Subject

Cancer Research,Oncology,General Medicine

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