Highlights
- •Postoperative pneumonia is a common complication of esophagectomy.
- •This study examined the impact of physical activity on postoperative pneumonia.
- •Walking less than 1494 steps per day post-surgery was a predictor of pneumonia.
- •Promoting physical activity such as walking may prevent postoperative pneumonia.
Abstract
Purpose
Physical activity is important to improve recovery following surgery. This study investigated
the impact of physical activity on the development of pneumonia after radical esophagectomy
in patients with thoracic esophageal cancer in the subacute phase from postoperative
day 11 to hospital discharge.
Methods
This retrospective cohort study included 83 patients who underwent radical esophagectomy
for esophageal cancer between 2016 and 2022. Physical activity was measured using
an activity tracker, and the average number of steps between postoperative days 8
and 10 was examined. The primary outcome was pneumonia (Clavien-Dindo classification
2 or higher) developing between postoperative day 11 and hospital discharge. We used
the receiver operating characteristic (ROC) curve analysis to calculate the optimal
cutoff value of physical activity that can predict the development of pneumonia and
define low physical activity. We used logistic regression analysis to investigate
the impact of low physical activity on postoperative pneumonia.
Results
Pneumonia developed in 10 patients (12.0%) during the observation period. The optimal
cutoff value of physical activity for predicting pneumonia was 1494 steps per day
(sensitivity: 60.0%, specificity: 89.0%, area under the curve: 0.743). In multivariate
analysis, low physical activity was an independent predictor of incident pneumonia
[odds ratio: 12.10, 95% confidence interval: 2.21–65.90, p = 0.004], with adjustment
for age, gastric tube reconstruction route, and postoperative recurrent nerve palsy.
Conclusions
Physical activity following radical esophagectomy in patients with thoracic esophageal
cancer was an independent predictor of the development of pneumonia in the subacute
phase after radical esophagectomy.
Keywords
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Article info
Publication history
Published online: January 23, 2023
Accepted:
January 22,
2023
Received:
November 23,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
