Esophageal Cancer Surgery in Elderly Patients 80 Years of Age or Older

Optimal discharge planning for esophagectomy patients with enhanced recovery after surgery: Recommendations

Background

Studies have suggested that the postoperative length of stay (PLOS) of esophagectomy patients under the enhanced recovery after surgery (ERAS) pathway should be >10 days as against the previously recommended 7 days. We investigated the distribution and influencing factors of PLOS in the ERAS pathway in order to recommend an optimal planned discharge time.

Methods

This was a single-center retrospective study of 449 patients with thoracic esophageal carcinoma who underwent esophagectomy and perioperative ERAS between January 2013 and April 2021. We established a database to prospectively document the causes of delayed discharge.

Results

The mean and median PLOS were 10.2 days and 8.0 days (range: 5-97), respectively. Patients were divided into four groups: group A (PLOS ≤ 7 days), 179 patients (39.9%); group B (8 ≤ PLOS ≤ 10 days), 152 (33.9%); group C (11 ≤ PLOS ≤ 14 days), 68 (15.1%); group D (PLOS > 14 days), 50 patients (11.1%). The main cause of prolonged PLOS in group B was minor complications (prolonged chest drainage, pulmonary infection, recurrent laryngeal nerve injury). Severely prolonged PLOS in groups C and D were due to major complications and comorbidities. On multivariable logistic regression analysis, open surgery, surgical duration >240 min, age >64 years, surgical complication grade >2, and critical comorbidities were identified as risk factors for delayed discharge.

Conclusions

The optimal planned discharge time for patients undergoing esophagectomy with ERAS should be 7-10 days with a 4-day discharge observation window. Patients at risk of delayed discharge should be managed adopting PLOS prediction.

Incidence and causes of postoperative delirium in patients with esophageal cancer

AIM: To investigate the incidence and causes of postoperative delirium in patients with esophageal cancer.

METHODS: We conducted a retrospective cohort analysis of 124 patients who had undergone an esophagectomy at Tianjin Medical University General Hospital from January 2010 to December 2012. All quantitative data and all qualitative data were analyzed using Student's t test and Chi-square test, respectively.

RESULTS: Postoperative delirium developed in 60 (48.4%) of 124 patients. Elder age (P = 0.007), history of mental illness (P = 0.0001), longer period of time under mechanical ventilation after surgery (P = 0.0001), longer ICU stay after surgery (P = 0.0001), longer period of prohibiting drinking and eating from mouth after surgery (P = 0.0001), and occurrence of postoperative complications (P = 0.002) were significantly associated with the development of postoperative delirium.

CONCLUSION: The development of postoperative delirium in patients with esophageal cancer is a problem that should not be ignored. Causes of postoperative delirium include elder age, history of mental illness, longer periods of time under mechanical ventilation after surgery, longer postoperative ICU stays, longer periods of prohibiting drinking and eating from mouth after surgery, and occurrence of postoperative complications.

Incidence and risk factors of postoperative delirium in patients with esophageal cancer

BACKGROUND

Postoperative delirium is a common complication after major surgery and is characterized by acute confusion with fluctuating consciousness. The aim of this study was to investigate the incidence and risk factors of postoperative delirium in patients with esophageal cancer.

METHODS

We conducted a retrospective cohort analysis of 306 consecutive patients who had undergone an esophagectomy at Keio University Hospital from January 1998 to December 2009. All data were assessed by psychiatrists, and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder, fourth edition. Univariate and multivariate analyses were performed.

RESULTS

Postoperative delirium developed in 153 (50.0 %) of 306 patients. One hundred fourteen (37.3 %) of the 306 patients required psychoactive medication for symptoms associated with delirium. Univariate analyses showed that older age, male gender, additional flunitrazepam for sedation in intensive care unit (ICU) after surgery, longer periods of time under mechanical ventilation after surgery, longer ICU stays, occurrence of postoperative complications, and longer hospital stays were significantly associated with postoperative delirium. Multivariate analysis revealed that development of delirium was linked to older age, additional flunitrazepam in ICU, and occurrence of postoperative complication.

CONCLUSIONS

The development of postoperative delirium in patients with esophageal cancer is a problem that cannot be ignored. Our results suggest that the risk of developing delirium is associated with older age, use of flunitrazepam in ICU, and postoperative complications.