Perioperative fluid management and major respiratory complications in patients undergoing esophagectomy

Esophageal surgery is often related to a high morbidity and mortality rate despite an improvement in postoperative care. Fluid administration has been described to be a factor that contributes to the development of postoperative respiratory complications after esophageal surgery. The aim was to study the relation between intraoperative and postoperative fluid administration and the development of respiratory complications after esophageal surgery. Patients undergoing esophageal surgery for cancer were selected from a prospective nonrandomized computer database. All of the patients underwent esophagectomy according to the Lewis-Tanner approach. Single-lung ventilation was used in all of the patients during the thoracic approach. The patients were divided in two groups with respect to the development of respiratory complications. Variables studied were American Society of Anesthesiologist Score, sex, preoperative chemoradiotherapy, albumin, smoking history, time until extubation, epidural analgesia, and fluid administration intraoperatively and 5 days postoperatively. Forty-five patients were included in the study. Respiratory complications were observed in nine patients (20%). None of the variables studied except fluid administration (P= 0.005 - odds ratio = 1.001 -95% confidence interval) were shown as a risk factor for the development of respiratory complications on the multivariate analysis. Fluid administration intraoperatively and postoperatively has shown to be a contributing factor for the development of respiratory complications after esophageal surgery.