Infectious morbi-mortality in thoracic surgery after major resections

Eight thousand major pulmonary resections are performed annually in France for bronchopulmonary cancer. This surgery is associated with a significant mortality rate, estimated at 3% within 30 days, mainly due to infectious pulmonary complications. In recent series, early mortality reaches 12.6% in cases of postoperative pneumonia (POP). Our case-control study aims to describe the incidence, mortality and risk factors of infectious complications in the Department of Thoracic, Cardiac, and Vascular Surgery, Tours University Hospital, France.

We identified 404 major resection procedures from the EPITHOR database between January 2019 and December 2021, of which 60 required postoperative antibiotic therapy. Demographic and perioperative data were compared between the "Antibiotic therapy" group and the rest of the cohort to identify risk factors. Bacteriological and therapeutic data from the "Antibiotic therapy" group were analyzed subsequently.

The incidence of POP was 8.9%, associated with a hospital mortality rate of 11.3%. Extension of operative time (OT) over 180 minutes [odds ratios (OR) 1.95, 95% confidence interval (CI): 1.01-3.75, P=0.06], right upper lobectomy (RUL) (OR 2.53, 95% CI: 1.31-4.86, P=0.005), thoracotomy approach (OR 2.68, 95% CI: 1.44-4.97, P=0.002), impairment of diffusing capacity of the lungs for carbon monoxide (DLCO) below 50% (OR 3.68, 95% CI: 1.58-8.53, P=0.002), and prolonged air leaks (OR 7.98, 95% CI: 2.87-22.2, P<0.001) were associated with higher rates of post-operative pneumonia. H. influenzae was the most frequently responsible bacteria, identified in 14% of cases. Overall sensitivity of these identified bacteria to amoxicillin-clavulanic acid was 75%.

Our results are consistent with literature regarding the incidence, mortality and risk factors of infectious complications after major pulmonary resection. The main risk factors identified were prolonged OT over 180 minutes, thoracotomy approach, RUL, preoperative impairment of DLCO below 50% and prolonged air leaks. Moreover, most of the bacteria responsible for POP have an amoxicillin-clavulanic acid sensitivity.