Effects Related To Scvo(2)-Guided Preoperative Optimisation In Open Transhiatal Oesophagectomy Patients: An Observational Evaluation Study

BackgroundMost studies on pre-operative optimization are in heterogenous high risk surgical patient groups and results suggest that interventions aimed to improve the hemodynamic condition may exert beneficial effects. Open transhiatal esophagectomy is associated with considerable postoperative morbidity and mortality. Pre-operative optimization of the circulation may result in a reduction of in-hospital-LOS, risk for anastomotic leakage and prevent infection/sepsis. The effects of pre-operative optimization in this group of patients are unknown.MethodsFollowing implementation of pre-operative optimization, 68 patients were compared to 32 patients operated prior to implementation. Optimization started one day before the esophagectomy in the ICU. A ScvO(2) <70% was treated with fluids and inotropics according to protocol.ResultsSepsis occurred in 4% of optimized and 25% of control patients (p=0.004), anastomic leakage occurred in 12% of optimized patients and 25% of control patients (p=0.14). Optimized patients were less likely to be re-admitted to the ICU (p=0.07) and had a shorter median in-hospital-LOS of 10 [9-15] vs 16 [13-35] days (p<0.001). A targeted ScvO(2)>70% was achieved in 77% of the optimized patients, in the optimized group delta ScvO(2) increased with 4 [0-7]%. Patients not reaching the target ScvO(2) were more likely to have a cardiovascular medical history (73% vs 37% p<0.02).ConclusionIn this observational evaluation study targeted on preoperative ScvO(2)-guided optimisation of patients treated with an open transhiatal oesophagectomy, we observed an association with a shorter in-hospital length of stay and less infectious complications. These results suggest that preoperative optimisation could be beneficial in this specific group of high-risk surgical patients.