Infectious morbi-mortality in thoracic surgery after major resections

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Infectious Diseases

Background:

• Major pulmonary resections for lung cancer carry a significant mortality risk, primarily from infectious complications.
• Postoperative pneumonia (POP) is a severe complication, with reported early mortality rates as high as 12.6%.
• This study investigates the incidence, mortality, and risk factors of infectious complications following major pulmonary resections.

Purpose of the Study:

• To determine the incidence and mortality rates of infectious complications after major pulmonary resections.
• To identify perioperative risk factors associated with the development of postoperative pneumonia.
• To analyze the bacteriology and antibiotic sensitivity of causative agents in POP.

Main Methods:

• A case-control study analyzed 404 major resection procedures from the EPITHOR database (January 2019 - December 2021).
• Data from 60 patients requiring postoperative antibiotic therapy were compared to controls to identify risk factors.
• Bacteriological and therapeutic data were subsequently analyzed.

Main Results:

• The incidence of POP was 8.9%, with a hospital mortality rate of 11.3%.
• Risk factors for POP included operative time >180 minutes, right upper lobectomy, thoracotomy approach, impaired diffusing capacity of the lungs for carbon monoxide (DLCO) <50%, and prolonged air leaks.
• Haemophilus influenzae was the most common pathogen (14%), with 75% sensitivity to amoxicillin-clavulanic acid.

Conclusions:

• Findings align with existing literature on the incidence, mortality, and risk factors of infectious complications post-pulmonary resection.
• Prolonged operative time, thoracotomy, right upper lobectomy, preoperative DLCO impairment, and air leaks are significant risk factors for POP.
• Most identified bacterial pathogens remain susceptible to amoxicillin-clavulanic acid, guiding empirical treatment.