Complete lobar collapse following pulmonary lobectomy. Its incidence, predisposing factors, and clinical ramifications.
OBJECTIVE
To define the most severe form of postlobectomy atelectasis and determine its incidence, predisposing factors, and clinical ramifications.


METHODS
Retrospective case control.


METHODS
The thoracic surgery unit at a 900-bed tertiary care hospital.


METHODS
Two hundred eighteen patients undergoing pulmonary lobectomy or bilobectomy over a 7-year time period.


RESULTS
Severe postlobectomy atelectasis (SPLA) was defined as complete ipsilateral lobar or bilobar collapse with whiteout of the involved lobe(s) and mediastinal shift on the chest radiograph. Data were collected consisting of patient age, lobe(s) resected, type of postoperative pain control, length of hospital and ICU stay, preoperative pulmonary function, and single- vs double-lumen tube intubation during surgery. The incidence of SPLA was 7.8%, comprising 24.6% of all postoperative complications seen. There was no statistically significant difference in patient age, preoperative room air PO2, and preoperative FEV1/FVC ratio for the SPLA group vs the group without this complication. Patients with SPLA had significantly longer ICU stays (112.7 h vs 28.4 h; p < 0.001) and hospital stays (14.7 days vs 9.3 days; p < 0.001) than the patients without complications. Patients undergoing right upper lobectomy, both alone or in combination with the right middle lobe, had a significantly higher incidence of SPLA when compared with all other types of resections (15.5% vs 3.0%; p < 0.005). There was no influence on the incidence of SPLA when the types of postoperative pain control regimen and endotracheal tubes used were examined.


CONCLUSIONS
We conclude that SPLA as defined in this study is an important postoperative complication with a significant incidence. Although patients undergoing right upper lobectomy are markedly predisposed to this problem, the exact pathophysiology remains unclear. Factors shown to be causes of less severe forms of postoperative atelectasis do not seem to contribute to the formation of SPLA, indicating that these two complications may be two unrelated entities.
Korst
R J
RJ
Department of Surgery, Harford Hospital, Connecticut, USA.
Humphrey
C B
CB
D000368:Aged; D000399:Air Pressure; D000700:Analgesics / Q000627:therapeutic use; D001999:Bronchoscopy; D003422:Critical Care; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000295:instrumentation; D007902:Length of Stay; D008168:Lung / Q000601:surgery; D010149:Postoperative Pain / Q000517:prevention & control; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013902:Radiography, Thoracic; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014797:Vital Capacity
D000700:Analgesics