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Preoperative bacterial culture can predict severe pneumonia in patients receiving esophagectomy

Akinao Kaneta, Takahiro Sato, Hiroshi Nakano, Takuro Matsumoto, Takeshi Tada, Yohei Watanabe, Hiroyuki Hanayama, Suguru Hayase, Zenichiro Saze, Koji Kono

Author information

  • Akinao Kaneta

    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

  • Takahiro Sato

    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

  • Hiroshi Nakano

    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

  • Takuro Matsumoto

    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

  • Takeshi Tada

    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

  • Yohei Watanabe

    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

  • Hiroyuki Hanayama

    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

  • Suguru Hayase

    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

  • Zenichiro Saze

    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

  • Koji Kono

    Department of Gastrointestinal Tract Surgery, Fukushima Medical University

Abstract

Background:Postoperative pneumonia is one of the major complications after esophagectomy. The aim of this study was to determine whether bacterial cultures before esophagectomy could predict occurrence of postoperative pneumonia and help treatment strategies for postoperative pneumonia.


Methods:Sixty-nine patients who underwent subtotal esophagectomy at Fukushima Medical University Hospital between January 2017 and May 2021 were included in this study. We collected sputum, oral, and/or nasopharyngeal swabs for bacterial culture preoperatively from all patients and from those who were suspected of postoperative pulmonary infections. We compared cultured pathogenic bacteria obtained preoperatively and postoperatively from patients who developed postoperative pneumonia, and investigated their association with incidence of postoperative pneumonia.


Results:Postoperative pneumonia occurred in 22 of 69 patients (31%), including 13 cases of severe pneumonia with a Clavien-Dindo classification of grade IIIa or higher. Multivariate analysis revealed that longer operative duration (for 30 minutes increase;odds ratio 1.27, 95% CI 1.01-1.51, p=0.039) and positivity for preoperative bacterial culture (odds ratio 5.03, 95% CI 1.31-19.2, p=0.018) were independent risk factors for severe postoperative pneumonia, but not for all incidences of postoperative pneumonia. Of note, in only 5 of the 22 patients with pneumonia, the same pathogenic species were detected preoperatively and after the onset of pneumonia.


Conclusions:Our results imply that preoperative bacterial culture may be useful to predict severe postoperative pneumonia. However, it may not be useful in determining pathogenic bacteria responsible for postoperative pneumonia.

The cintent of reseach paper

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