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Impact of postoperative physical activity on the development of pneumonia in the subacute phase after esophagectomy in patients with esophageal cancer: A retrospective cohort study

  • Shin Kondo
    Correspondence
    Corresponding author. Division of Rehabilitation, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.
    Affiliations
    Division of Rehabilitation, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan

    Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
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  • Tatsuro Inoue
    Affiliations
    Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata, Niigata, 950-3198, Japan
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  • Takashi Saito
    Affiliations
    Division of Rehabilitation, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
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  • Takashi Fujikawa
    Affiliations
    Department of Rehabilitation, Kobe City Medical Center West Hospital, 2-4 ichiban-cho, Nagata-ku, Kobe, 653-0013, Japan
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  • Motomu Kamada
    Affiliations
    Division of Rehabilitation, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
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  • Seiya Inoue
    Affiliations
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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  • Satoshi Fujiwara
    Affiliations
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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  • Masakazu Goto
    Affiliations
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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  • Nori Sato
    Affiliations
    Department of Rehabilitation Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
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  • Rei Ono
    Affiliations
    Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan

    Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
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  • Toshihiro Akisue
    Affiliations
    Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
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  • Shinsuke Katoh
    Affiliations
    Department of Rehabilitation Medicine, Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities, 4-1 Shinbiraki, Chuden-cho, Komathushima-shi, Tokushima, 773-0014, Japan
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  • Hiromitsu Takizawa
    Affiliations
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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  • Tetsuya Matsuura
    Affiliations
    Department of Rehabilitation Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan
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Published:January 23, 2023DOI:https://doi.org/10.1016/j.ejon.2023.102270

      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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