Impact of atrial fibrillation on long-term survival following oesophagectomy: a 21-year observational study.

BACKGROUND: Post-operative atrial fibrillation (AF) is a common complication of oesophagectomy and thought to signal a complicated post-operative course. AF is associated with prolonged admissions, increased healthcare costs and inpatient mortality. However, the impact of post-operative AF on long-term outcomes remains uncertain. METHODS: Patients undergoing open Ivor-Lewis oesophagectomy from 1994 to 2014 at Palmerston North Hospital, New Zealand, were retrospectively evaluated. Demographic, perioperative and tumour variables were collected. Regression models were used to identify independent predictors of AF and assess post-discharge survival following oesophagectomy. RESULTS: In total, 89 patients were included. New-onset AF developed post-operatively in 27 patients (30%). Median follow-up was 6.3 years. Logistic regression identified volume of intravenous fluid in the first 24 h post-operatively as a predictor of AF. Post-discharge survival was predicted by AF occurrence (hazard ratio (HR): 2.99, 95% confidence interval (CI): 1.37-6.53, P = 0.006), preoperative chemoradiotherapy (HR: 0.43, 95% CI: 0.20-0.91, P = 0.03), 1-4 positive lymph nodes (HR: 2.29, 95% CI: 1.06-4.96, P = 0.04), ≥5 positive nodes (HR: 2.95, 95% CI: 1.25-6.94, P = 0.01) and year of operation from 2008 to 2014 (HR: 0.30, 95% CI: 0.12-0.75, P = 0.01). CONCLUSION: Post-operative AF was associated with poorer long-term survival following oesophagectomy in this cohort. Further research should evaluate the influence of AF on cardiovascular and oncological outcomes following oesophagectomy.

Short and long term outcomes of oesophagectomy in a provincial New Zealand hospital.

BACKGROUND: Oesophagectomy is a complex procedure associated with a significant morbidity and mortality rate. There is very little published data from New Zealand, with no published data from a non-Tertiary New Zealand hospital. We aimed to evaluate the outcomes of oesophagectomy at a single provincial hospital in New Zealand. METHOD: Retrospective review of clinical records of all patients who underwent oesophagectomy at Palmerston North Hospital (a level II provincial New Zealand public hospital) between 1993 and 2010 was performed. Demographic data, operative details, postoperative recovery parameters, survival data, pathological data, and details of adjuvant treatment were collected. RESULTS: Data from all 68 patients who underwent oesophagectomy were included. Mean age was 63.6 plus or minus 10.9 years, and 69% of patients were male. Mean operating time was 438.37 plus or minus 101.8 min, and mean intraoperative blood loss was 934.5 plus or minus 790.2 ml. Median intensive care unit stay was 7 (1-29) days, and total day stay was 17.5 (4-60) days. Tracheostomy was performed in 20 patients (29.4%). Anastomotic leak occurred in 7 patients (10.3%), chylothorax in 6 patients (8.8%) and cardiopulmonary complications in 34 patients (50.0%). The all cause in-hospital mortality rate was 4.4%. Overall survival at 30 days was 98.5%, at 1 year was 78.3% and at 5 years was 30.3%. CONCLUSION: Survival outcomes of oesophagectomy in this provincial New Zealand hospital are comparable to published series from national and international tertiary centres.