| Pneumonia was the most common postoperative pulmonary complications for patients with esophagectomy, which has been reported in several literatures. Many studies have revealed that various factors may lead to pulmonary complications, including advanced age, abnormal chest radiograph3, diabetes mellitus, history of major operation and abnormal lung function test, low serum albumin5, and postoperative analgesia6. However, little work has been done on the prediction of pneumonia, which may be different from other pulmonary complications. Postoperative pneumonia could be divided into two groups, as we consider them different causes. In some cases, pneumonia occurred after an uneventful operation without any obvious predisposing factor and it is called primary pneumonia. By contrast, some cases are clearly the consequence of a complicated procedure or other postoperative morbidities. These cases were defined as secondary pneumonia. With the development of perioperative management of esophagectomy, the incidence of pneumonia decreased, especially for secondary pneumonia7,8. Knowledge of which patients are at higher risk for primary pneumonia may contribute to selection of patients for surgical intervention, institution of risk reduction measures, and allocation of resources for postoperative care.Pulmonary function test has been considered as independent prediction factors of postoperative pulmonary complications9 and long-term survival 10. But investigators put more emphasis on forced expiratory volume in 1 second%(FEV1%), forced vital capacity(FVC)9,11 and diffusion capacity of the lung for carbon monoxide (DLCO) 11, little attention has been done on peak expiratory flow (PEF), which may be a more practical physiologic measurement to obtain from physically debilitated or having cognitive impairment elderly persons12,13. PEF represented the ability to cough effectively and was correlated with the pleural pressure during FVC manoeuvre. In addition, patients with central airway obstruction or upper airway occlusion may have lower PEF without a decrease in FEV1 and /or VC, so normal or higher PEF may be related with decreased likelihood of aspiration of oropharyngeal bacteria into the lower respiratory tract. As individual institution and clinical trials do not have a common system for documenting the occurrence or severity of complications associated with esophagectomy, it may lead to discordance in reporting surgical complications as well as differ in conclusions. We conducted this study to identify factors that were related with postoperative primary pneumonia after esophagectomy according to the proposed system for defining and recording associated with esophagectomy by the Esophagectomy Complications Consensus Group.We performed a retrospective review of 2 independent cohorts including 216 patients who underwent esophagectomy between November 2011 and May 2014, aiming at identifying predictors of primary pneumonia. Univariate analysis was used to identify potential covariates for the development of primary pneumonia. Adjustments for multiple comparisons were made using False Discovery Rate (FDR) (Holm-Bonferroni method). Multivariable logistic regression analysis was used to identify independent predictors and construct a regression model based on a training cohort (n=166) and then the regression model was validated using an independent cohort (n=50). It showed that low PEF (hazard ratio 0.97, P=0.009) was independent risk factors for the development of primary pneumonia in multivariate analyses and had a predictive effect for primary pneumonia (AUC=0.691and 0.851 for training and validation data set, respectively). Therefore, PEF has clinical value in predicting postoperative pneumonia after esophagectomy and it may serve as an indicator of preoperative lung function training. |
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