• Djamel Mokart, Emmanuelle Giaoui, Louise Barbier, Jérôme Lambert, Antoine Sannini, Laurent Chow-Chine, Jean-Paul Brun, Marion Faucher, Jérôme Guiramand, Jacques Ewald, Magali Bisbal, Jean-Louis Blache, Jean-Robert Delpero, Marc Leone, and Olivier Turrini.
• Réanimation Polyvalente, Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France. Electronic address: mokartd@ipc.unicancer.fr.
• J Crit Care. 2016 Feb 1; 31 (1): 48-53.

BackgroundMajor postoperative events (acute respiratory failure, sepsis, and surgical complications) are frequent early after elective gastroesophageal and pancreatic surgery. It is unclear whether these complications impact equally on long-term outcome.MethodsProspective observational study including the patients admitted to the surgical intensive care unit between January 2009 and October 2011 after elective gastroesophageal and pancreatic surgery. Risk factors for 30-day major postoperative events and long-term outcome were evaluated.ResultsDuring the study period, 259 patients were consecutively included. Among them, 166 (64%), 54 (21%), and 39 (15%) patients underwent pancreatic surgery, gastric surgery, and esophageal surgery, respectively. Using the Clavien-Dindo classification, 117 patients (45%) developed at least 1 postoperative complication, including 60 (23%) patients with acute respiratory failure, 77 (30%) with sepsis, and 89 (34%) with surgical complications. The median follow-up from the time of intensive care unit admission was 34 months (95% confidence interval, 30-37 months). The 1-year survival was 95% (95% confidence interval, 92-98). Among the perioperative variables, postoperative sepsis and an American Society of Anesthesiologists score higher than 2 were independently associated with long-term mortality. In septic patients, death (n = 16) was significantly associated with cancer recurrence (n = 10; P < .0001). Independent factors associated with postoperative sepsis were a Sequential Organ Failure Assessment score on day 1, a systemic inflammatory response syndrome on day 3, positive intraoperative microbiological samples, Simplified Acute Physiology Score II and an American Society of Anesthesiologists score higher than 2 (P < .005).ConclusionsPostoperative sepsis was the only major postoperative event associated with long-term mortality. Postoperative sepsis may reflect a deep impairment of immune response, which is potentially associated with cancer recurrence and mortality.Copyright © 2015 Elsevier Inc. All rights reserved.

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