OGC P48 The Relationship between Hospital Acquired Pneumonia (HAP) and Synchronous Post-Operative Complications following Oesophagectomy: An Assessment of the impact on mortality

Abstract

Abstract Background Hospital Acquired Pneumonia (HAP) is a frequently occurring complication following oesophagectomy, often associated with poorer outcomes. After oesophagectomy, HAP can occur in conjunction with other pulmonary and non-pulmonary complications such as anastomotic leak. Single lung ventilation during oesophagectomy can lead to altered lung function, contributing to infective and non-infective respiratory complications. Understanding the interplay between these factors is crucial for recognizing the multifaceted nature of HAP and identifying areas of focus to reduce its incidence. This study aimed to quantify the incidence of HAP in relation to other complications, and assess the effect of pulmonary complications on long-term outcomes. Methods This was a retrospective review of all consecutive oesophagectomies undertaken at a regional OG cancer centre serving a population of 3.5 million people between 2014-2022. Data was extracted from the Electronic Patient Records. Datapoints included patient demographics; comorbidities; post-operative course and re-admissions. Clinical details and radiological reports (Computed Tomography and Chest X-Ray) on the day of HAP diagnosis (defined using the CDC criteria) were recorded, alongside evidence of pneumothorax, pleural effusion, emphysema and Acute Respiratory Distress Syndrome (ARDS). Complications were defined using the Esophagectomy Complications Consensus Group (ECCG) definitions. Survival analysis was conducted on STATA. Results 460 patients were included, 356 (77.40%) were male. 223 (48.5%) were treated for HAP - 56 (12.2%) met the CDC criteria. 125 (60.10%) patients treated for HAP had concurrent pleural effusion, 60 (28.85%) pneumothorax, & 12 (5.77%) surgical emphysema. 53 patients (25.49%) had two concurrent findings. 17/53 (32%) patients with anastomotic leak also had HAP. 5-year OS between patients treated for HAP who met the CDC criteria versus those who did not meet the criteria were similar. There was no difference in OS between patients with HAP versus no respiratory complications. Patients with no complications had the highest 5-year survival. Conclusions A significant proportion of patients develop HAP after oesophagectomy, usually alongside concurrent pulmonary complications. A significantly higher number of patients were treated for HAP than met the CDC criteria, highlighting the complexity in diagnosing post-operative complications. Our results suggest that a diagnosis of HAP is not a predictor for poorer long-term survival. Further research is warranted to elucidate the underlying mechanisms and refine treatment approaches in this patient population.