Risk factors of postoperative respiratory infections in lung cancer surgery.
BACKGROUND
Postoperative infections have been a major issue in lung cancer surgery. We changed our perioperative prophylactic antibiotic policy to a single dose of cefazolin before and after surgery in July 2002.


OBJECTIVE
To identify the risk factors of postoperative pneumonia and empyema in lung cancer patients undergoing surgical resection.


METHODS
From July 1992 through September 2003, 2105 patients underwent primary lung cancer resection at our division. We reviewed 1855 eligible patients for possible risk factors of pneumonia and empyema.


RESULTS
Postoperative respiratory infections developed in 69 (3.7%) patients. There were 58 (3.1%) pneumonia cases and 18 (1.0%) cases of empyema. The mortality rate was 0.8% (15 patients). Nine (0.5%) patients died from postoperative respiratory infections. Multivariate analysis showed age 75 years or older, forced expiratory volume in 1 second as a percentage of forced vital capacity (FEV1%) less than 70%, advanced pathologic stage, and induction therapy to be independent risk factors of pneumonia. For postoperative empyema, advanced age was the significant factor. Twelve of 18 patients (67%) with empyema were complicated with bronchopleural fistula. The infection incidence rate did not change significantly after we modified our prophylactic antibiotic policy to a single dose of cefazolin before and after surgery.


CONCLUSIONS
Lung cancer patients with advanced age, low FEV1%, advanced pathologic stage, or induction therapy had a risk for pneumonia after lung cancer surgery. Postoperative empyema was associated with advanced age.
Shiono
Satoshi
S
Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. sshiono@ypch.gr.jp
Yoshida
Junji
J
Nishimura
Mitsuyo
M
Hagiwara
Masaru
M
Hishida
Tomoyuki
T
Nitadori
Jun-ichi
J
Nagai
Kanji
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000627:therapeutic use; D016724:Empyema, Pleural / Q000209:etiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011014:Pneumonia / Q000209:etiology; D016156:Respiratory Tract Fistula / Q000209:etiology; D012141:Respiratory Tract Infections / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D002437:Cefazolin