Long Term Outcomes Following Emergency Intensive Care Readmission after Elective Oesophagectomy

Abstract

Objective : The purpose of this study was to analyse the outcomes of patients readmitted to ICU following initial recovery after oesophagectomy.Background : Surgery for oesophageal cancer has significant morbidity and poor long-term outcomes. There is limited evidence concerning the long-term outcomes of patients who require readmission to the intensive care unit (ICU) after an initial recovery following resection.Method : The case notes of 221 patients who underwent elective oesophagectomy over an eleven-year period were reviewed. Patients who were readmitted to ICU following initial recovery were identified and the clinical and demographic characteristics of these patients were prospectively recorded and their outcomes analysed. Results : A total of 43 patients were readmitted to ICU during the study period mainly for respiratory complications or anastomotic leaks. 17 patients (40%) required a period of mechanical ventilation; 16 patients (37%) required inotropes and 2 patients (5%) required renal support. The mean ICU stay on readmission was 8 days (range 0–49 days) with an inhospital mortality rate of 33%. In terms of long-term outcomes, the actuarial two-and five-year survival rates were 42.3 ± 7.7% and 36.7 ± 8.5% respectively. Multivariate analysis identified both age (Hazard ratio: 1.05 ± 0.02; p = 0.04) and requirement for renal support (Hazard ratio: 5.63 ± 0.8; p = 0.03) as independent adverse predictors of survival. Conclusions : Although ICU readmission following elective oesophagectomy is associated with significant mortality, the overall long-term survival rate for these patients, particularly those who do not require renal support is encouraging.