Postoperative respiratory infection is a major issue in lung cancer surgery. Empyema is a troublesome complication and can lead to a long hospital stay. The aim of this study is to identify the risk factors of postoperative empyema in lung cancer surgery and to clarify the clinical characteristics of these patients.
From January 2001 through December 2008, 1247 patients underwent primary lung cancer resection at our department. We reviewed these patients for possible risk factors of empyema and assessed their clinical characteristics. In univariate and multivariate statistical analyses, the logistic regression model was used to evaluate the risk factors associated with postoperative empyema.
Postoperative empyema developed in 32 (2.6%) patients. Multivariate analysis revealed gender (male sex; p = 0.010, OR=4.9), history of diabetes mellitus (p = 0.045, OR=1.34), prior operation (p = 0.016, OR=2.75), pneumonectomy cases (p < 0.001, OR=6.23), prolonged air leakage (more than 7 days; p = 0.03, OR=1.78), and bronchopleural fistula (p < 0.001, OR=6.24) were independent risk factors for postoperative empyema. The postoperative mortality due to postoperative empyema was 0.3% (4 patients). Multiple surgical interventions were required to cure postoperative empyema in 16 out of 32 patients who had postoperative empyema. In the latter period (from January 2005 to December 2008), the rate of postoperative empyema had decreased.
Postoperative empyemas achieved relative high mortality after lung cancer surgery. We identified that postoperative empyema in lung cancer surgery was associated with gender, the history of diabetes mellitus, prior operation, pneumonectomy, prolonged air leakage, and bronchopleural fistula.
Knowledge of the conditions that place patients at high risk for empyema and of the well-established principles of bronchial stump closure is crucial to preventing empyemas.
Makoto Takahama, No Financial Disclosure Information; No Product/Research Disclosure Information