Masoomi Hossein, Nguyen Brian, Smith Brian R, Stamos Michael J, Nguyen Ninh T
Department of Surgery, University of California, Irvine, Medical Center, Orange, California 92868, USA.
Am Surg. 2012 Oct;78(10):1024-8.
Acute respiratory failure (ARespF) is a common complication after esophagectomy that contributes to higher morbidity and mortality. Using the Nationwide Inpatient Sample database, we sought to identify predictors of ARespF in 6352 patients who underwent esophagectomy for malignancy between 2006 and 2008. Multivariate regression analyses were performed to identify preoperative factors (patient characteristics, comorbidities, procedural type, tumor's location, hospital teaching status, and payer type) predictive of ARespF in esophagectomy. The overall rate of ARespF was 27.08 per cent. For comorbidities, independent risk factors for higher rate of ARF included weight loss (adjusted odds ratio [AOR], 3.63; 95% confidence interval [CI], 3.02 to 4.37), pulmonary hypertension (AOR, 2.38; 95% CI, 1.85 to 3.45), congestive heart failure (AOR, 2.35; 95% CI, 1.77 to 3.13), liver disease (AOR, 1.95; 95% CI, 1.22 to 3.12), chronic lung disease (AOR, 1.40; 95% CI, 1.17 to 1.66), and anemia (AOR, 1.26; 95% CI, 1.04 to 1.51). Cervical location of malignancy (AOR, 2.32; 95% CI, 1.51 to 3.56), total esophagectomy (AOR, 1.64; 95% CI, 1.41 to 1.90), and nonteaching hospital (AOR, 1.45; 95% CI, 1.20 to 1.75) were independent risk factors for ARespF. There was no effect of age, gender, race, hypertension, diabetes, renal failure, obesity, smoking, peripheral vascular disorder, or payer type on ARespF. We identified multiple preoperative risk factors that have an impact on development of ARespF after esophagectomy. Surgeons can use these factors to inform patients of potential risks and should consider these factors during surgical-decision making.
急性呼吸衰竭（ARespF）是食管切除术后常见的并发症，会导致更高的发病率和死亡率。利用全国住院患者样本数据库，我们试图在2006年至2008年间接受恶性肿瘤食管切除术的6352例患者中确定ARespF的预测因素。进行多因素回归分析以确定术前因素（患者特征、合并症、手术类型、肿瘤位置、医院教学状况和付款人类型）对食管切除术中ARespF的预测作用。ARespF的总体发生率为27.08%。对于合并症，ARF发生率较高的独立危险因素包括体重减轻（调整比值比[AOR]，3.63；95%置信区间[CI]，3.02至4.37）、肺动脉高压（AOR，2.38；95%CI，1.85至3.45）、充血性心力衰竭（AOR，2.35；95%CI，1.77至3.13）、肝病（AOR，1.95；95%CI，1.22至3.12）、慢性肺病（AOR，1.40；95%CI，1.17至1.66）和贫血（AOR，1.26；95%CI，1.04至1.51）。恶性肿瘤位于颈部（AOR，2.32；95%CI，1.51至3.56）、全食管切除术（AOR，1.64；95%CI，1.41至1.90）和非教学医院（AOR，1.45；95%CI，1.20至1.75）是ARespF的独立危险因素。年龄、性别、种族、高血压、糖尿病、肾衰竭、肥胖、吸烟、外周血管疾病或付款人类型对ARespF无影响。我们确定了多个术前危险因素，这些因素会影响食管切除术后ARespF的发生。外科医生可以利用这些因素告知患者潜在风险，并在手术决策时应考虑这些因素。
