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EVALUATING POSTOPERATIVE MICROASPIRATION IN ESOPHAGECTOMY PATIENTS
Evelyn Alexander
*, Ahmed A. Elkamel, Shamele Battan-Wraith, Timothy Harris, Kevin Wang, Mazin Abdalgadir, Jonathan Rice, Praveen Sridhar, Stephanie Worrell
Banner - University Medical Center Tucson, Tucson, AZ
Objective: This study aimed to evaluate the relationship between microaspiration identified on postoperative computed tomography (CT) and clinical, demographic, and surgical characteristics in esophagectomy patients. The goal was to identify potential predictors of microaspiration and its impact on patient outcomes.
Methods: A retrospective analysis was conducted on 44 patients who underwent esophagectomy between 2022 and 2024. Postoperative microaspiration was identified by reviewing CT scans taken more than one month after surgery. The patients were divided into two groups: those with post-operative microaspiration (n=25) and those without (n=13). Data collected included demographic information, comorbidities, tumor staging, type of esophagectomy, and postoperative outcomes. Variables analyzed included age, sex, Charlson Comorbidity Index (CCI), preoperative CT findings, jejunostomy tube placement, neoadjuvant therapy, and postoperative complications such as gastroparesis, stricture formation, and mortality.
Results: Of the 44 patients, 25 (57%) showed evidence of microaspiration on postoperative CT. There was no significant difference in age between the groups (67.8 vs 66.0, p=0.4). Other characteristics, such as sex (p=0.13), race (p=0.42), and CCI (p=0.86), also did not differ significantly. The length of stay (LOS) was 3 days longer in the microaspiration group (12.5 vs. 9.5 days, p=0.35) and each additional day increased the odds of microaspiration by 3.3% (OR = 1.03; 95% CI: 0.96–1.12). Postoperative complications were more frequent in the microaspiration group, including gastroparesis (16.7% vs. 0%, p=0.05). Mortality rates were higher for patients with microaspiration (26.1% vs. 7.7%, p=0.28). Cervical anastomosis as associated with a 2-fold increase in odds of developing microaspiration compared to an intrathoracic anastomosis (p = 0.47; 95% CI: 0.24–22.1). Preoperative CT findings of microaspiration doubled the odds of postoperative microaspiration (p=0.34, OR = 2.01; 95% CI: 0.48–8.46). However, logistic regression did not identify any statistically significant predictors (Table 2).
Conclusions: Microaspiration is a common following esophagectomy, affecting over half of the patients in this study. Our data suggest that cervical anastomosis and preoperative microaspiration may increase the risk of postoperative microaspiration. Despite being underpowered to detect significant differences, these trends highlight the clinical relevance. The observed trends suggest that close monitoring of patients with preoperative microaspiration or cervical anastomosis could help reduce postoperative complications.
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