Early Extubation After Thoracic Esophagectomy Restricts Fluid Overload and Prevents Pulmonary Complications and Surgical Site Infections: A Retrospective Cohort Study.

Background: Esophagectomy is an invasive treatment for esophageal cancer associated with postoperative complications and mortality. Herein, to prevent postoperative complications, early extubation (EE) in the operating room without overnight mechanical ventilation (MV) was introduced. Methods: We compared overnight MV and EE to evaluate the impact on short-term outcomes post-esophagectomy. In total, 91 patients with thoracic esophageal cancer who underwent subtotal esophagectomy were included. In total, 26 patients were extubated in the operating room postoperatively (EE group), and 65 were extubated the following morning (MV group). Propensity score matching was used to assemble a well-balanced cohort. The clinical and postoperative outcomes were investigated; the postoperative fluid balance in the intensive care unit was compared between groups. Results: Propensity score matching produced 21 paired cases from the cohort; the groups were comparable. The EE group had a lower operative time and fluid-in/out balance in the intensive care unit than the MV group. Regarding postoperative outcomes, the EE group had shorter postoperative hospital and intensive care unit stays. In addition, the EE group had significantly fewer incidences of pulmonary complication and surgical site infection. Conclusions: EE was associated with shorter postoperative hospital and intensive care unit stays and reduced incidence of pulmonary complications and surgical site infections by preventing volume overload in the intensive care unit.