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Published on: November 10, 2023
Surgical Site Infection in Lung Transplantation: Clinical Impact and Predictive Factors: Analysis From the Portuguese
Catarina Pereira Moita1, Zenito Cruz1, Ana Inácio1
1Thoracic Surgery Department, Hospital de Santa Marta, Unidade Local de Saúde São José, Lisbon, Portugal; Centro Clínico Académico de Lisboa, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal.
Introduction:
Surgical site infection (SSI) after lung transplantation is an under-reported complication, despite its potential impact on postoperative morbidity and clinical outcomes. This study aims to evaluate the clinical impact and identify predictors of SSI in lung transplant recipients.
Methods:
A retrospective observational study was conducted including patients who underwent lung transplantation at the Portuguese Lung Transplantation Center between January 2016 and December 2024, with follow-up until June 2025. Univariate and multivariate analyses were performed to identify independent predictors.
Results:
Among 316 transplanted patients, 25 (7.9%) developed SSI. Deep infections represented 80% of cases, including 5 with sternal osteomyelitis, occurring at a median of 25 days post-transplant (IQR: 17-43). Gram-negative bacteria were most frequently isolated, particularly Enterobacteriaceae. Negative-pressure wound therapy was used in 17 (68%) patients, and 8 (32%) required surgical debridement. Patients with SSI were older, predominantly female and had a higher body mass index (BMI). Moreover, they presented significantly longer ICU stay, drainage duration and hospital stay (all p < .05). No significant differences were observed regarding primary graft dysfunction, acute or chronic rejection, or mortality. In multivariate analysis, female sex (OR 3.15; 95% CI: 1.33-7.48) and higher BMI (OR 1.21; 95% CI: 1.05-1.32) were risk factors for SSI.
Conclusion:
SSI after lung transplantation is associated with significant postoperative morbidity, underscoring that this complication, although underestimated, remains clinically relevant. The incidence observed in our center (7.9%) is comparable to that reported in the literature. Early identification of high-risk patients may support the implementation of tailored strategies and optimize perioperative management.
