355 Early Noradrenaline Use as a Marker of Post-Operative Complications Following Oesophagectomy: Comparison Between Robotic and Hybrid/Open Approaches

Abstract Aim To evaluate early noradrenaline use as a predictor of major complications following oesophagectomy and compare usage between robotic and hybrid/open approaches. Method A retrospective cohort study was conducted at a high-volume UK centre, including 205 consecutive patients who underwent oesophagectomy between May 2022 and March 2025. Patients were stratified into two groups:Robotic-assisted minimally invasive oesophagectomies (RAMIO), utilising paravertebral analgesia; andHybrid/open oesophagectomies with open thoracotomy, utilising epidural analgesia. Noradrenaline use, average dose, and peak dose within 72 hours post-operatively were analysed in relation to major complications (Clavien-Dindo ≥IIIb). Univariate analysis and ROC curves identified dose thresholds associated with adverse outcomes. Results Across both cohorts, noradrenaline use within 72 hours post-operatively was associated with Clavien-Dindo ≥IIIb complications (64% vs 42.8%, p = 0.0547). There were significantly higher average (0.0320 vs 0.0000 mcg/kg/min, p = 0.0039) and peak doses (0.050 vs 0.000 mcg/kg/min, p = 0.0061) for those with major complications in the hybrid/open approach. Vasopressor requirements were significantly greater in hybrid/open procedures (p = 0.0234). For all patients, thresholds of average ≥0.070 mcg/kg/min and peak ≥0.095 mcg/kg/min were associated with increased odds of major complications (AUC ≈ 0.66). Conclusions Early noradrenaline use is a clinically useful marker of physiological stress and predicts major complications following oesophagectomy. Paravertebral analgesia use in RAMIO is associated with lower vasopressor requirements. Incorporating vasopressor data into risk stratification may support earlier identification of at-risk patients and optimise recovery pathways.