POSTSPLENECTOMY PULMONARY RESECTION : RISK FACTORS FOR AN AVOIDABLE COMPLICATION

Abstract Background Owing to the unsatisfactory results of antibiotic treatment alone, surgical resection is currently considered as adjunctive therapy in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, reports regarding the outcomes of surgery vary considerably by institution. Here, we investigated the surgical outcomes and risk factors associated with unfavorable outcomes after surgery. Methods We analyzed patients with NTM-PD who underwent pulmonary resection at Seoul National University Hospital between January 1, 2006, and December 31, 2020, and assessed the types of surgical procedures, complications, and long-term outcomes. Multivariate logistic regression analysis was used to identify the risk factors associated with treatment refractoriness or recurrence after surgery. Results Among 67 patients who underwent surgery during the study period, the most common indication for surgery was persistent culture positivity despite rigorous medical treatment (80.6%), followed by longstanding cavitary lesions or radiographic aggravation (10.4%) and massive hemoptysis (4.5%). Among 53 patients with positive mycobacterial cultures at the time of surgery, 38 (71.7%) achieved initial negative culture conversion, 9 (17.0%) of whom experienced recurrence. Nine (14.3%) patients experienced postoperative complications, which were managed without lasting morbidity and mortality. Female sex (adjusted odds ratio [aOR], 6.63; 95% confidence interval [CI], 1.04–42.4; P = .046), preoperative positive mycobacterial culture (aOR, 5.87; 95%CI, 1.04–33.08; P = .045), and residual lesions (aOR, 6.86; 95%CI, 1.49–31.56; P = .013) were associated with refractoriness or recurrence. Conclusions Pulmonary resection is a reasonable treatment modality for patients with refractory NTM-PD or major complications such as massive hemoptysis. The potential risk factors for unfavorable outcomes included female sex, preoperative positive mycobacterial culture, and residual lesions after surgery.

Download Full-text

Bronchopleural Fistula after Pulmonary Resection: Risk Factors, Diagnoses and Management

10.5772/intechopen.100209 ◽

2021 ◽

Author(s):

Kristina Jacobsen

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Respiratory Distress ◽

Conservative Management ◽

Endoscopic Treatment ◽

Pulmonary Resection ◽

Bronchopleural Fistula ◽

Patient Characteristics ◽

Pleural Space ◽

Life Threatening

Bronchopleural fistula (BPF) after a pulmonary resection is rare with some of the most life-threatening consequences and a high mortality rate. Contamination of the pleural space resulting in empyema and spillage of the infected fluid into the remaining lung leading to respiratory distress remain the biggest concerns with BPF postoperatively. There are many patient characteristics and risk factors that can be evaluated to decrease the chance of a postoperative BPF. Presentation of BPF can be early or late with the late BPF more difficult to diagnosis and manage. Many options to treat BPF include surgical repair, conservative management, and endoscopic treatment.

Download Full-text