Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients

Abstract

Background The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied. Methods Prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastrostomy for esophageal cancer. Intraoperative Hypotension (IOH), defined as Systolic Blood Pressure (SBP) < 90 mm Hg lasting more than 5 minutes, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak and prolonged hospital stay were analyzed as outcome variables Result A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. Mean duration of the surgery was 208 minutes. Intraoperative mean low SBP was 80mmHg while the lowest record was 55 mmHg. IOH occurred in 51 .2 % (n=29) of patients; of these, 7.4% (n=4) had anastomotic leak (OR 1.2, 95% CI 0.26-6.3; p=0.76) , mortality was 5.5% (n=3) (OR 1.44, 95% CI 0.22- 9.3; p =0.7) and 33 % (n=18) had prolonged hospital stay (OR 0.53, 95% CI 0.14- 1.9; p=0.34 ).Over all anastomotic leak rate was 13% (n=7). The 30 days operative mortality was 9.2% and 55 % (30) of patients had prolonged hospital stay. Multivariate analysis (logistic regression model) showed SBP < 90mmHg for more than 5 minutes was not significantly associated either with individual or composite out comes of mortality, anastomotic leak and prolonged hospital stay (AOR 1.06 ,95% CI 0.98-1.14; p=0.16) Conclusion In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association either with individual or composite adverse outcomes of mortality, anastomotic leak and prolonged hospital stay.