title: Early reoperation performed for the management of complications in patients undergoing general thoracic surgical procedures.
abstract: OBJECTIVE
  To detect the rate and predisposing factors for the development of postoperative complications requiring re-operation for their control in the immediate postoperative period.
  
  
  METHODS
  During the time period 2009-2012, 719 patients (male: 71.62%, mean age: 54±19 years) who underwent a wide range of general thoracic surgery procedures, were retrospectively collected. Data of patients who underwent early re-operation for the management of postoperative complications were assessed for identification of the responsible causative factors.
  
  
  RESULTS
  Overall, 33/719 patients (4.6%) underwent early re-operation to control postoperative complications. Early re-operation was obviated by the need to control bleeding or to drain clotted hemothoraces in nine cases (27.3%), to manage a prolonged air leak in six cases (18.2%), to drain a post-thoracotomy empyema in five cases (15.2%), to revise the thoracotomy incision or an ischemic musculocutaneous flap in five cases (15.2%), to manage a bronchopleural fistula in four cases (12.1%), to manage persistent atelectasis of the remaining lung in two cases (6.1%), to cease a chyle leak in one case (3%) and to plicate the right hemidiaphragm in another one case (3%). The factors responsible for the development of complications requiring reopening of the chest for their management were technical in 17 cases (51.5%), initial surgery for lung or pleural infections in 9 (27.3%), the recent antiplatelet drug administration in 4 (12.1%) and advanced lung emphysema in 3 (9.1%). Mortality of re-operations was 6.1% (2/33) and it was associated with the need to proceed with completion pneumonectomy in the two cases with persistent atelectasis of the remaining lung and permanent parenchymal damage. The majority of complications requiring reoperation were observed after lung parenchyma resection (17 out of the 228 procedures/7.4%) or pleurectomy (7 out of the 106 procedures/6.5%). Reoperations after video-assisted thoracic surgery (VATS) were uncommon (2 out of the 99 procedures/2%).
  
  
  CONCLUSIONS
  The rate of complications requiring reoperation after general thoracic surgery procedures is low and it is mainly related to technical issues from the initial surgery, the recent administration of antiplatelet drugs, the presence of advanced emphysema and surgery for infectious diseases. The need to proceed with completion pneumonectomy has serious risk for fatal outcome.
authors.affiliation: 1 AHEPA University Hospital, Cardiothoracic Surgery Department, Aristotle University of Thessaloniki, Greece ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital.
authors.forename: Christophoros N
authors.initials: CN
authors.lastname: Foroulis
authors.affiliation: 1 AHEPA University Hospital, Cardiothoracic Surgery Department, Aristotle University of Thessaloniki, Greece ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Kleontas
authors.affiliation: 1 AHEPA University Hospital, Cardiothoracic Surgery Department, Aristotle University of Thessaloniki, Greece ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital.
authors.forename: Avgerinos
authors.initials: A
authors.lastname: Karatzopoulos
authors.affiliation: 1 AHEPA University Hospital, Cardiothoracic Surgery Department, Aristotle University of Thessaloniki, Greece ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital.
authors.forename: Chryssoula
authors.initials: C
authors.lastname: Nana
authors.affiliation: 1 AHEPA University Hospital, Cardiothoracic Surgery Department, Aristotle University of Thessaloniki, Greece ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital.
authors.forename: George
authors.initials: G
authors.lastname: Tagarakis
authors.affiliation: 1 AHEPA University Hospital, Cardiothoracic Surgery Department, Aristotle University of Thessaloniki, Greece ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital.
authors.forename: Paschalis
authors.initials: P
authors.lastname: Tossios
authors.affiliation: 1 AHEPA University Hospital, Cardiothoracic Surgery Department, Aristotle University of Thessaloniki, Greece ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital.
authors.forename: Paul
authors.initials: P
authors.lastname: Zarogoulidis
authors.affiliation: 1 AHEPA University Hospital, Cardiothoracic Surgery Department, Aristotle University of Thessaloniki, Greece ; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Anastasiadis
keywords: General thoracic surgery; early reoperation; post-thoracotomy complications; postoperative complications; reoperation; rethoracotomy