Preoperative screening with respiratory failure risk index reduces postoperative pulmonary complications in esophagectomy patients

Background: Postoperative pulmonary complications (PPCs) greatly contribute to the risks for various surgeries. Prevention of PPCs is an important issue in the perioperative management. We previously reported usefulness of respiratory failure risk index (RFRI) for prediction of PPCs after digestive surgeries. Aims: This study investigated whether preoperative screening with RFRI was effective in preventing PPCs after esophagectomy. Methods: The patients who were scheduled to have esophagectomy from July 2013 to June 2014 were enrolled. The risk for PPCs was preoperatively assessed by RFRI calculated from surgical site, serum albumin, blood urea nitrogen, functional status, pulmonary function, and age. We defined those who scored over 27 out of 57 points of RFRI as high-risk patients for PPCs and applied preoperative pulmonary rehabilitation to them. The patients who underwent esophagectomy in the previous year were set as a control group. Results: 26 (male/female 25/1, mean age 70.5±7.9) and 27 patients (male/female 26/1, mean age 69.6±8.3) were enrolled in the preoperative screening and in the control group, respectively. There was no significant difference in the patient characteristics or surgical procedures between the two groups. In the preoperative screening and in the control group, 9 and 11 patients respectively satisfied the high-risk criteria. The incidence of PPCs in the preoperative screening group (7.7%) was significantly lower than that of the control group (37%, p =0.02). Conclusions: This study suggests that perioperative interventions to the patients selected by preoperative screening with RFRI may reduce PPCs after esophagectomy.