Clinical Study Of Acute Lung Injury And Acute Kidney Injury After Esophageal Cancer Surgery

Objectives:To develop a new approach for identifying acute lung injury(ALI)in surgical ward setting and to assess incidence rate,clinical outcomes,and risk factors for ALI cases after esophagectomy.We also compare the degree of lung injury between operative and non-operative sides.Methods:Consecutive esophageal cancer patients(n=1022)who underwent esophagectomy from Dec 2012 to Nov 2018 in the Affiliated Hospital of Qingdao University were studied.An approach for identifying ALI was proposed that integrated radiographic assessment of lung edema(RALE)score to quantify degree of lung edema.Stepwise logistic regression identified risk factors for postoperative ALI incidence.The degree of bilateral lung injury was compared using the RALE score.Results:The approach for identifying ALI in surgical ward setting was defined as acute onset,Pa O₂/Fi O₂?300 mm Hg,bilateral opacities on bedside chest radiograph with a RALE score?16,and exclusion of cardiogenic pulmonary edema.Incidence rate of ALI was estimated to be 9.7%.ALI diagnosis was associated with multiple clinical complications,prolonged hospital stay,higher medical bills,and higher perioperative mortality.Nine risk factors including BMI,ASA class,DLCO%,duration of surgery,neutrophil percentage,high-density lipoprotein,and electrolyte disorders were identified.The RALE score of the lung lobes of the operative side was higher than the non-operative side.Conclusions:A new approach for identifying ALI in esophageal cancer patients receiving esophagectomy was proposed.ALI is common and has severe outcomes.Several risk factors were identified.Strict preoperative preparation,proficient intraoperative operation,and meticulous postoperative management can reduce the occurrence of ALI.The lung lobes on the operative side in patients after esophagectomy are more likely to be affected than the non-operative side.Objectives: To explore the incidence rate,risk factors and clinical outcomes of acute kidney injury(AKI)after esophagectomy.Methods: We retrospectively analyzed 947 patients who underwent esophagectomy and had preoperative and postoperative renal function examination in the Affiliated Hospital of Qingdao University from Dec 2012 to Nov 2018,including 896 males and 51 females at median age of 61(55,66)years.To identify risk factors for postoperative AKI by performing univariate and multivariate logistic regression analyses,and to explore its clinical outcomes.Results: Incidence rate of AKI after esophagectomy was 4.01%(38/947).Multivariate logistic analysis showed that age?55(OR=3.604,95%CI 1.046 12.416,P=0.042),hypertension(OR=2.59,95%CI 1.108⁴.609,P=0.025),dyslipidemia(lipoprotein a / per SD)(OR=1.492,95%CI 1.195¹.862,P=0.001),duration of surgery(per 1h)(OR=1.348,95%CI 1.097¹.655,P=0.004),tumor T stage(?T3)(OR=2.68,95%CI 1.017⁷.065,P=0.046)were independent risk factors for postoperative AKI.The occurrence of AKI was related to the increase in postoperative anastomotic leakage,postoperative time of hospitalization and total hospitalization costs(P<0.05).Conclusions: Patients with advanced age,hypertension,dyslipidemia,longer operation time,and higher tumor T stage were high-risk groups for postoperative AKI.Although the incidence rate of postoperative AKI is low,mostly mild and self-limiting.It will lead to postoperative anastomotic leakage,prolonged the time of hospitalization,higher medical bills,and potentially life-threatening.High-risk groups should be closely monitored during the perioperative,and to prevent the occurrence of AKI as well as early detection and treatment.