Early postoperative non-steroidal anti-inflammatory drugs and anastomotic leakage after oesophagectomy

Hirano, Yuki; Konishi, Takaaki; Kaneko, Hidehiro; Itoh, Hidetaka; Matsuda, Satoru; Kawakubo, Hirofumi; Uda, Kazuaki; Matsui, Hiroki; Fushimi, Kiyohide; Daiko, Hiroyuki; Itano, Osamu; Yasunaga, Hideo; Kitagawa, Yuko

doi:10.1093/bjs/znac399

Cited by 5 publications

(3 citation statements)

References 43 publications

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“…However, in Japan, patients undergoing 3-field lymph node dissection generally receive cervical anastomosis, whereas those undergoing 2-field lymph node dissection receive intrathoracic anastomosis 48 . Therefore, we considered that the field of lymph node dissection reflected the anastomosis site 49 . Moreover, the instrumental variable analyses could have adjusted for such unmeasured confounders.…”

Section: Discussionmentioning

confidence: 99%

“…48 Therefore, we considered that the field of lymph node dissection reflected the anastomosis site. 49 Moreover, the instrumental variable analyses could have adjusted for such unmeasured confounders. Second, because minimally invasive esophagectomy is reimbursed separately from open esophagectomy by the Japanese public universal insurance system since April 2014, information on the thoracic approach was not included in the database for patients before April 2014.…”

Section: Discussionmentioning

confidence: 99%

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Antimicrobial Prophylaxis with Ampicillin-sulbactam Compared with Cefazolin for Esophagectomy

Hirano,

Konishi,

Kaneko

et al. 2023

Annals of Surgery

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Objective: To assess the effect of antimicrobial prophylaxis with ampicillin-sulbactam (ABPC/SBT) compared with cefazolin (CEZ) on the short-term outcomes after esophagectomy. Summary Background Data: CEZ is widely used for antimicrobial prophylaxis in esophagectomy without procedure-specific evidence, whereas ABPC/SBT is preferred in some hospitals to target both aerobic and anaerobic oral bacteria. Methods: Data of patients who underwent esophagectomy for cancer between July 2010 and March 2019 were extracted from a nationwide Japanese inpatient database. Overlap propensity score weighting was conducted to compare the short-term outcomes [including surgical site infection (SSI), anastomotic leakage, and respiratory failure] between antimicrobial prophylaxis with CEZ and ABPC/SBT, after adjusting for potential confounders. Sensitivity analyses were also performed using propensity score matching and instrumental variable analyses. Results: Among 17,772 eligible patients, 16,077 (90.5%) and 1695 (9.5%) patients were administered CEZ and ABPC/SBT, respectively. SSI, anastomotic leakage, and respiratory failure occurred in 2971 (16.7%), 2604 (14.7%), and 2754 patients (15.5%), respectively. After overlap weighting, ABPC/SBT was significantly associated with a reduction in SSI [odds ratio 0.51 (95% confidence interval 0.43–0.60)], anastomotic leakage [0.51 (0.43–0.61)], and respiratory failure [0.66 (0.57–0.77)]. ABPC/SBT was also associated with reduced respiratory complications, postoperative length of stay, and total hospitalization costs. The proportion of Clostridioides difficile colitis and noninfectious complications did not differ between the groups. Propensity score matching and instrumental variable analyses demonstrated equivalent results. Conclusions: The administration of ABPC/SBT as antimicrobial prophylaxis for esophagectomy was associated with better short-term postoperative outcomes compared to CEZ.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antimicrobial Prophylaxis with Ampicillin-sulbactam Compared with Cefazolin for Esophagectomy

Hirano,

Konishi,

Kaneko

et al. 2023

Annals of Surgery

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“…We examined the proportion of patients who underwent early extubation at each hospital during the study period 20 – 22 ; early extubation was defined as extubation on the day of surgery without requiring mechanical ventilation on the day after surgery. Hospitals were categorized into four groups with approximately equal numbers of patients in each group according to the proportions of early extubation: very low (<11%); low (11–37%); medium (38–83%); high (≥84%).…”

Section: Methodsmentioning

confidence: 99%

Proportion of early extubation and short-term outcomes after esophagectomy: a retrospective cohort study

Hirano

Konishi

Kaneko

et al. 2023

International Journal of Surgery

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Background: The proportion of early extubation after esophagectomy varies among hospitals; however, the impact on clinical outcomes is unclear. The aim of this retrospective study was to evaluate associations between the proportion of early extubation in hospitals and short-term outcomes after esophagectomy. Because there is no consensus regarding the optimal timing for extubation, the authors considered that hospitals’ early extubation proportion reflects the hospital-level extubation strategy. Materials and methods: Data of patients who underwent oncologic esophagectomy (July 2010–March 2019) were extracted from a Japanese nationwide inpatient database. The proportion of patients who underwent early extubation (extubation on the day of surgery) at each hospital was assessed and grouped by quartiles: very low- (<11%), low- (11–37%), medium- (38–83%), and high-proportion (≥84%) hospitals. The primary outcome was respiratory complications; secondary outcomes included reintubation, anastomotic leakage, other major complications, and hospitalization costs. Multivariable regression analyses were performed, adjusting for patient demographics, cancer treatments, and hospital characteristics. A restricted cubic spline analysis was also performed for the primary outcome. Results: Among 37 983 eligible patients across 545 hospitals, early extubation was performed in 17 931 (47%) patients. Early extubation proportions ranged from 0–100% across hospitals. Respiratory complications occurred in 10 270 patients (27%). Multivariable regression analyses showed that high- and medium-proportion hospitals were significantly associated with decreased respiratory complications [odds ratio, 0.46 (95% CI, 0.36–0.58) and 0.43 (0.31–0.60), respectively], reintubation, and hospitalization costs when compared with very low-proportion hospitals. The risk of anastomotic leakage and other major complications did not differ among groups. The restricted cubic spline analysis demonstrated a significant inverse dose-dependent association between the early extubation proportion and the risk of respiratory complications. Conclusion: A higher proportion of early extubation in a hospital was associated with a lower occurrence of respiratory complications, highlighting a potential benefit of early extubation after esophagectomy.

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Impact of postoperative NSAIDs administration on anastomotic leak after esophago-gastric surgery: systematic review and meta-analysis

et al. 2023

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Early postoperative non-steroidal anti-inflammatory drugs and anastomotic leakage after oesophagectomy

Cited by 5 publications

References 43 publications

Antimicrobial Prophylaxis with Ampicillin-sulbactam Compared with Cefazolin for Esophagectomy

Antimicrobial Prophylaxis with Ampicillin-sulbactam Compared with Cefazolin for Esophagectomy

Proportion of early extubation and short-term outcomes after esophagectomy: a retrospective cohort study

Impact of postoperative NSAIDs administration on anastomotic leak after esophago-gastric surgery: systematic review and meta-analysis

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