Prediction of early bronchopleural fistula after pneumonectomy: a multivariate analysis.
BACKGROUND
The aim of this study was to determine independent risk factors for early bronchopleural fistula (BPF) after pneumonectomy and to assess the efficacy of bronchial coverage in preventing this complication.


METHODS
We reviewed 242 consecutive patients undergoing pneumonectomy for lung cancer. The bronchial stump was covered with autologous tissue in 178 patients (74%). Perioperative data were recorded to identify risk factors of BPF by univariate and multivariate analyses.


RESULTS
Overall morbidity and mortality rates were 59% and 5.4%, respectively. The incidence of BPF was 5.4%. By univariate analysis, patients with chronic obstructive pulmonary disease (COPD; p = 0.017), hyperglycemia (p = 0.003), hypoalbuminemia (p = 0.017), previous steroid therapy (p < 0.001), poor predicted postpneumonectomy forced expiratory volume in 1 second (FEV1; p = 0.012), long bronchial stumps (p < 0.001), and mechanical ventilation (p = 0.015), were related with higher risk of BPF. In the multiple logistic regression model, the independent risk factors of BPF were the bronchial stump coverage and length, side of pneumonectomy, predicted postpneumonectomy FEV1, COPD, and mechanical ventilation.


CONCLUSIONS
Bronchial stump coverage is highly recommended in all cases to minimize the risks of BPF. A shorter length of the bronchial stump and early extubation may prevent the development of BPF. Careful attention must be paid to those patients with COPD and poor predicted postpneumonectomy FEV1.
Algar
F J
FJ
Department of Thoracic Surgery, Hospital Universitario Reina Sofia, Córdoba, Spain. med015662@nacom.es
Alvarez
A
A
Aranda
J L
JL
Salvatierra
A
A
Baamonde
C
C
López-Pujol
F J
FJ
D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010995:Pleural Diseases / Q000453:epidemiology / Q000209:etiology*; D011013:Pneumonectomy / Q000009:adverse effects*; D012307:Risk Factors