Pulmonary resection for active infection has ben considered hazardous. However, the lung is often the source of the septic response and its attendant risks; therefore resection of the affected lung is often necessary and therapeutic. We saught to evaluate the risks and benefits of pulmonary parenchymal resection for infection.
We retrospectively reviewed the records of 39 patients, ages 16-68 who underwent pulmonary resection for an infectious process. Demographic, bacteriologic, radiologic and comorbid disease factors were analyzed for risks, perioperative variables and outcomes. We utlized chi square tables for categorical values and T tests between groups and Fisher’s exaxt t test. MS Excel 97 was used to copy the data to a STRATA file for analysis.
39 patients underwent 27 lobectomies, 7 pneumonectomies, 4 local excisions and one VATS wedge. Four patients died (10.2%). Factors influencing complications (bleeding, reoperation, prolonged air leak, reoperation empyema, respiratory failure and persistent sepsis) included preoperative weight loss, operative blood loss and transfusion, and active preoperative sepsis as a surgical indication. Factors influencing mortality include blood loss exceeding 1000cc, with trends toward significance of extent of resection (pneumonectomy). Sepsis and organ failure caused all deaths. Postoperative empyema occurred only twice, but postoperative sepsis comoplicated the recovery in 18% of patients.
Active sepsis adversely affected outcomes following parenchymal resection of pulmonary infection. Efforts to control the sepsis and earlier surgical intervention may improve survival and limit the extend of resection. Semielective resections appears safe and effective.
Earlier intervention for patients requiring surgical excision of parenchymal infectious processes may improve outcome.
N.J. Snow, None.