Association Of Impaired Heart Rate Recovery(HRR) With Cardiopulmonary Complications After Esophagectomy

Objective Patients who undergo esophagus cancer resection surgery are at risk for postoperative cardiopulmonary complications(CPCs). Appropriate evaluation and preparation before surgery is crucial in the treatment of esophagus cancer. Previous studies have shown that heart rate recovery(HRR) is a measure of overall physical fitness. This study is to investigate the association of impaired heart rate recovery(HRR) with cardiopulmonary complications after esophagus carcinoma resection surgery.Methods Patients with esophagus carcinoma who were admitted in The First Affiliated Hospital of Anhui Medical University between July 2015 and September 2015 underwent heart rate recovery(HRR) evaluation after 6-minute walk test before surgery. Impaired heart rate recovery was defined as a 18-beat or less decrease in peak heart rate at 1 minute after the 6-minute walk test. Postoperative cardiopulmonary complications were defined by the Society of Thoracic Surgeons General Thoracic surgery Database. Compare the two groups with clinical data and postoperative cardiopulmonary complications. The Student t tests and Pearson’s chi-square tests were used to compare the characteristics of the two groups.Results(1)A total of 108 patients underwent surgical resection for esophagus cancer during the study period. 103 patients(mean age 63.5±8.7, 23 female and 80 male) who accorded with the inclusion criteria were enrolled. Heart rate recovery(HRR) evaluation after 6MWT were conducted before surgery. The number of patients with impaired HRR was 36, normal HRR was 67. Two patients died within 30 days after the surgery. There are no statistically significant differences in general clinical characteristics between the two groups.(2) O f those 103 patients, 31 had postoperative cardiopulmonary complications(CPCs). The top 3 CPCs were atelectasis(9 patients, 8.73%), pneumonia(7 patients, 6.79%), pleural effusion with drainage(7 patients, 6.79%).(3)The incident rate of postoperative cardiopulmonary complications was higher in patients with impaired heart rate recovery(χ2=5.415,p=0.020), and the postoperative hospital stay timer was longer too(t=-4.053,p<0.01).Conclusions Impaired heart rate recovery is associated with postoperative cardiopulmonary complications. HRR<18 beats/minute can predict more postoperative cardiopulmonary complications(CPCs) in patients with esophagus carcinoma, and the risk is higher. It indicates that proper prepare should be done before surgery to get a better prognosis.