The role of surgery type in postoperative atrial fibrillation and in-hospital mortality in esophageal cancer patients wi
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(2020) 18:244
RESEARCH
Open Access
The role of surgery type in postoperative atrial fibrillation and in-hospital mortality in esophageal cancer patients with preserved left ventricular ejection fraction Laite Chen1†, Lu Zhang2†, Lu Shi2, Guosheng Fu1 and Chenyang Jiang1*
Abstract Background: Postoperative atrial fibrillation (POAF) is one of the most common complications of esophagectomy, which may extend the inpatient hospital stay. Minimally invasive esophagectomy (MIE) has been increasingly used in clinical practice; however, its POAF risk and short-term mortality remain unclear. This study aimed to examine the POAF risk and in-hospital mortality rate between patients receiving MIE and open esophagectomy (OE). Methods: Esophageal cancer patients who underwent MIE or OE from a retrospective cohort study were evaluated. A multivariate logistic regression model was built to assess the associations between esophagectomy (MIE vs. OE) and various outcomes (POAF, in-hospital mortality). Covariates included age, sex, body mass index, neoadjuvant therapy, tumor stage, surgery incision type, comorbidities, cardia conditions, peri-operative medication, and complications. Results: Of the 484 patients with esophageal cancer, 63 received MIE. A total of 53 patients developed POAF. Compared to patients receiving OE, MIE patients had 81% reduced odds of POAF (adjusted odds ratio [aOR] 0.185, 95% CI 0.039–0.887, P = 0.035). No statistically significant association was found for in-hospital mortality (aOR 0.709, 95% CI 0.114–4.409, P = 0.712). Conclusions: MIE is associated with a lower risk of POAF, compared to traditional surgery. No significant short-term survival benefit was found for MIE. Keywords: Esophagectomy, Postoperative atrial fibrillation, Minimally invasive surgery, Esophageal cancer, Mortality
Introduction Postoperative atrial fibrillation (POAF) is one of the most common complications of esophagectomy that often occur within 3 days after esophagectomy [1]. Studies showed that POAF could lead to a longer hospital * Correspondence: [email protected] † Lu Zhang is the co-first author and Laite Chen and Lu Zhang contributed equally to this work. 1 Department of Cardiology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Zhejiang 310000, Hangzhou, China Full list of author information is available at the end of the article
stay and a greater incidence of other complications [2]. POAF risk is higher among patients who are older [3], racial/ethnic minorities [4], taking perioperative medications such as β-blocker [5], and having hypertension [6] or operative trauma [7]. In recent decades, minimally invasive esophagectomy (MIE) has become the preferred procedure for esophagectomy due to its faster recovery and improved quality of life [8–10]. However, the association between MIE and the risk of POAF has not been well documented. For example, several studies investigating postoperative
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons
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