A New Clinical Scoring System to Define Pneumonia following Esophagectomy for Cancer

Abstract

Background: Pneumonia is a frequently observed complication following esophagectomy. The lack of a uniform definition of pneumonia leads to large variations of pneumonia rates in literature. This study was designed to develop a scoring system for diagnosing pneumonia following esophagectomy at the hospital ward. Methods: In a prospective cohort study of esophagectomy patients, known risk factors for pneumonia, temperature, leukocyte count, pulmonary radiography and sputum culture added were evaluated. Primary outcome was defined as the decision to treat suspected pneumonia. Multivariate Cox regression analysis with backward selection was used to identify predictors of pneumonia treatment. Results: The majority of postoperative pneumonia treatments (88.2%) occurred at the hospital ward, where treatment was observed in 67 (36.2%) of 185 patients. Independent diagnostic determinants for pneumonia treatment were temperature (hazard ratio (HR) = 1.283, p = 0.073), leukocyte count (HR = 1.040, p = 0.078) and pulmonary radiography (HR >11.0, p = 0.000). Sputum culture did not influence the decision to treat pneumonia. These findings were used to develop a scoring system which includes temperature, leukocyte count and pulmonary radiography. Conclusion: The decision to treat pneumonia is based on temperature, leukocyte count and pulmonary radiography findings. The proposed clinical scoring system for pneumonia following esophagectomy at the hospital ward has the potential to aid clinical practice and improve comparability of future research in esophageal cancer surgery.

Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status

“…9 Very few data are available on the effect on systematic inflammatory response to surgical trauma in case of HMIE. 15,16 Moreover, WBC resulted to be associated with anastomotic leak after esophagectomy in multivariate logistic regression with albumin and CRP. Maas et al 11 reported a peak of inflammatory activity after esophagectomy on day 1 as shown by IL8 serum level, thus, we considered CRP serum levels on day 1 as primary outcome.…”

Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer

“…Although postoperative recovery has improved owing to the introduction of minimally invasive techniques, centralization of surgery and enhanced recovery programmes, the postoperative complication rate remains high. The most common complication after oesophagectomy is pneumonia. Depending on the definition, up to 40 per cent of patients develop this complication.…”

Randomized Controlled Study to Evaluate the Efficacy of a Preoperative Respiratory Rehabilitation Program to Prevent Postoperative Pulmonary Complications after Esophagectomy

“…The CDC is a valuable tool that enables objective and detailed documentation, as well as defined grades of the severity of postoperative complications [10] . The UPSS was designed as a new clinical scoring system to define pneumonia following esophagectomy for cancer by van der Sluis et al [11] . The UPSS is estimated using temperature, the leukocyte count and pulmonary radiography findings.…”

“…However, the clinical efficacy of PR is unclear for patients with esophageal cancer who undergo esophagectomy. Therefore, the aim of this study was to clarify the efficacy of PR for reducing respiratory complications after esophagectomy as evaluated through the use of the Clavien-Dindo classification (CDC) [10] and the Utrecht Pneumonia Scoring System (UPSS) [11] .…”

“…Morning laboratory results were used to determine the white blood counts. The directed reports were used to interpret the chest radiographs ( table 1 ) [11] .…”