title: Reduction in airway complications after lung transplantation with novel anastomotic technique.
abstract: BACKGROUND
  Bronchial anastomotic complications develop in 31% of lung transplant recipients, leading to additional operative procedures and increased morbidity. Advances in surgical technique have thus far resulted in only modestly improved outcomes. We hypothesized that creating the bronchial anastomosis at the secondary carina using a combination of running and figure-of-eight sutures would minimize donor bronchial ischemia and airway complications.
  
  
  METHODS
  This retrospective review of a single surgeon's operative experience from 2000 to 2007 compares a new bronchial anastomotic technique with the conventional technique. The primary outcome was the occurrence of bronchial anastomotic complications requiring invasive intervention. The secondary outcome was distal airway complications. Patients were monitored for 1 year after transplant. Recipient and donor demographic data as well as relevant variables from their preoperative, perioperative, and postoperative courses were collected for analysis. These data were compared using t tests for normally distributed continuous variables, Mann-Whitney tests for nonnormally distributed continuous variables, and χ2 tests or Fisher exact test for categoric variables. Logistic regression was used to control for covariates while comparing the primary outcome between the new and conventional bronchial anastomotic techniques.
  
  
  RESULTS
  The analysis included 230 patients, representing 407 anastomoses. The occurrence of anastomotic complications requiring intervention and distal airway complications decreased from 18.1% to 2.3% of anastomoses and 12.2% to 4.4% of patients, respectively. After controlling for available risk factors, the new technique significantly reduced both anastomotic (p<0.001) and distal (p=0.03) airway complications.
  
  
  CONCLUSIONS
  This new anastomotic technique dramatically reduces anastomotic and distal airway complications after lung transplantation.
authors.affiliation: Division of Thoracic Surgery, University of Washington, Seattle, Washington 98195, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: FitzSullivan
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Gries
authors.forename: Patrick
authors.initials: P
authors.lastname: Phelan
authors.forename: Farhood
authors.initials: F
authors.lastname: Farjah
authors.forename: Erin
authors.initials: E
authors.lastname: Gilbert
authors.forename: John C
authors.initials: JC
authors.lastname: Keech
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Wood
authors.forename: Ganesh
authors.initials: G
authors.lastname: Raghu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Mulligan
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000517:prevention & control; D000714:Anastomosis, Surgical / Q000379:methods*; D001980:Bronchi / Q000601:surgery*; D001982:Bronchial Diseases / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013536:Suture Techniques; D016896:Treatment Outcome