Frequency of blood lactate elevation following esophagectomy and its association to postoperative complications

• Published in: Acta anaesthesiologica Scandinavica 2023-03, Vol.67 (3), p.277-283
• Main Authors: Linde, Henrik, Bartusevicius, Vilhelmas, Norberg, Åke, Klevebro, Fredrik, Grip, Jonathan
• Format: Article
• Language: English
• Subjects: Anastomotic leak; Anastomotic Leak - epidemiology; Anastomotic Leak - etiology; Anastomotic Leak - surgery; Blood; Blood levels; Comorbidity; Complications; early recovery program; esophageal cancer; Esophageal Neoplasms - complications; Esophageal Neoplasms - surgery; esophagectomy; Esophagectomy - adverse effects; Esophagectomy - methods; Humans; Hyperlactatemia; Intensive care; lactate; Lactic acid; Length of Stay; Medicin och hälsovetenskap; Minimally Invasive Surgical Procedures - adverse effects; Night; Patients; Postoperative; postoperative care; Postoperative Complications - epidemiology; Postoperative infection; Retrospective Studies; Surgery; Surgical anastomosis; Treatment Outcome
• ISSN: 0001-5172; 1399-6576; 1399-6576
• DOI: 10.1111/aas.14181

Background Esophagectomy is a major surgical intervention and a cornerstone in the treatment of esophageal cancer. There is clinical experience that blood lactate concentration often is elevated in the period following esophagectomy, but the incidence and clinical consequences are sparsely studied. Methods We extracted data from all patients undergoing esophagectomy at Karolinska University Hospital 2016–2018, n = 153. Most were performed with minimally invasive technique, n = 130. Blood lactate values directly after surgery, highest value during the first night, and morning level on postoperative day one were recorded. Primary outcome was hospital length of stay and secondary outcome was a composite of postoperative infection, additional surgery, or intensive care during the hospital stay. Development of anastomotic leak was analyzed separately. Results Postoperative hyperlactatemia was common as 93% of patients had peak lactate concentration >1.6 mmol/L and 27% >3.5 mmol/L in the first night following operation. Median hospital length of stay was 14 days. Blood lactate showed a weak correlation to hospital stay and intensive care the morning following surgery, but not at arrival to postoperative ward. There were no statistical differences between those with and without anastomotic leak at any of the time points. Elevated lactate in the first 12–16 h postoperatively was related to surgical factors (open technique, surgery time, and perioperative bleeding) but not to patient related factors (ASA‐class, Charlson comorbidity index, sex, age) or cumulative fluid balance. Conclusion In conclusion, elevated blood lactate in the immediate time following esophagectomy showed a weak association to intensive care and length of stay but not anastomotic leak.