Factors influencing mortality and morbidity following oesophageal resection
| Autor: | Fountain Sw, Griffin Sc, Townsend Er, Michael Charlton, Desai J |
|---|---|
| Rok vydání: | 1989 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Esophageal Neoplasms medicine.medical_treatment Adenocarcinoma Resection Esophagus Risk Factors Carcinoma medicine Humans Risk factor Mortality Aged Aged 80 and over Epithelioma business.industry Operative mortality Anastomosis Surgical Follow up studies Age Factors General Medicine Length of Stay Middle Aged medicine.disease Surgery Survival Rate medicine.anatomical_structure Esophagectomy Carcinoma Squamous Cell Female Morbidity Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 3(5) |
| ISSN: | 1010-7940 |
| Popis: | Operative mortality and morbidity following oesophageal resection has fallen in recent years. We have attempted to identify the factors responsible for this improvement by reviewing the results of surgery at this hospital over the last 6 years. Two hundred and two oesophageal resections were performed between January 1981 and June 1987 for carcinoma. Of these, 21 patients (10.4%) died before leaving hospital. Fourteen patients died of multisystem failure, 1 died of pure respiratory failure and 2 died of renal failure. Two died of surgical causes (other than anastomotic leak), 1 died of pulmonary embolus and 1 from a cerebro-vascular accident. No patient died of purely cardiac causes. The most significant risk factors in those dying (Chi-square test) were: postoperative respiratory failure, defined as reventilation after initial successful extubation, (P less than or equal to 0.001), reoperation as an emergency in the early postoperative period (P less than or equal to 0.001), anastomotic leak (P less than or equal to 0.01) and age over 70 (P less than or equal to 0.005). Less significant risk factors were chyle leak and histologically undifferentiated tumour. Of the 181 survivors, 103 left hospital with no complications of any kind. The mean stay in hospital for survivors was 15 days. Respiratory infection occurred in 22% of patients, prolonged gastric stasis in 8%, wound infection in 5% and empyema in 1%. As long as high risk groups are accepted for radical surgery, operation will carry a significant mortality in those groups. In others, we believe that perioperative monitoring and early aggressive treatment of complications can further reduce mortality and morbidity. |
| Databáze: | OpenAIRE |
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