title: Risk factors for bronchopleural fistula after right pneumonectomy: does eliminating the stump diverticulum provide protection?
abstract: OBJECTIVE
  Bronchopleural fistula (BPF) remains an important source of morbidity and mortality after right pneumonectomy. We reviewed our 18-year institutional experience with right pneumonectomy to identify risks factors for BPF.
  
  
  METHODS
  From 1992 to 2010, a total of 145 patients who underwent right pneumonectomy were identified from an institutional database. Median age was 56 years. Most patients (66.2%) underwent surgery for non-small cell lung cancer. Sixty-seven patients (46.2%) received either chemotherapy or radiotherapy before surgery. Medical records were reviewed for 14 variables potentially predictive for BPF, including two airway closure techniques (standard bronchial closure and carinal closure). Variables predictive of BPF by univariate analysis were entered into a logistic regression model.
  
  
  RESULTS
  The overall mortality rate was 13.1% (n=19), with 15.9 and 10.5% mortality in the bronchial closure and carinal closure groups, respectively (P=0.33). The overall BPF rate was 7.6% (n=11), with a 3.9% (3 of 76) rate in the carinal closure group compared to 11.6% (8 of 69) in the bronchial closure group (P=0.08). Seven of eight bronchial closure patients who developed BPF required operative repair. Only one of three patients who developed BPF after carinal closure did not spontaneously heal after open drainage. Multivariate analysis identified preoperative radiation dose (P=0.042) and bronchial closure (P=0.041) as independent risk factors for BPF, while the length of postoperative ventilation before development of BPF approached significance (P=0.057).
  
  
  CONCLUSIONS
  In our experience, higher preoperative radiation doses are a risk factor for BPF after right pneumonectomy, while carinal closure exerts a protective effect.
authors: Cardiothoracic Division, Department of Surgery, Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA. tbirdas@iupui.edu
authors: Thomas J
authors: TJ
authors: Birdas
authors: Mohamed H
authors: MH
authors: Morad
authors: Ikenna C
authors: IC
authors: Okereke
authors: Karen M
authors: KM
authors: Rieger
authors: Laura E
authors: LE
authors: Kruter
authors: Praveen N
authors: PN
authors: Mathur
authors: Kenneth A
authors: KA
authors: Kesler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001983:Bronchial Fistula / Q000209:etiology* / Q000517:prevention & control*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D004240:Diverticulum / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010995:Pleural Diseases / Q000209:etiology* / Q000517:prevention & control*; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D011292:Premedication; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult