title: Outcomes after pneumonectomy for benign disease: the impact of urgent resection.
abstract: BACKGROUND
  Pneumonectomy for benign disease is often complicated by inflammatory processes that obscure operative planes. We reviewed our experience to evaluate the impact of requiring urgent or emergent pneumonectomy on outcomes.
  
  
  METHODS
  All pneumonectomies for benign conditions from 1997 to 2012 at a single institution were retrospectively reviewed. Mortality was assessed using multivariable logistic regression that included laterality, age, and surgery status, which was emergent if performed within 24 hours of initial evaluation, urgent if performed after 24 hours but within the same hospital stay, and otherwise elective.
  
  
  RESULTS
  Among 42 pneumonectomies, completion pneumonectomy after previous ipsilateral lung resection was performed in 14 patients (33%). Resection was elective in 22 patients (52%), urgent in 12 (28%), and emergent in 8 (19%). The most common indication was for necrotic lung (n = 12; 29%). Muscle flaps were used in 26 patients (62%). Perioperative mortality for the entire cohort was 29% (n = 12) and was significantly higher when surgery was urgent (5 of 12; 42%) or emergent (5 of 8; 62.5%) compared with elective (2 of 22; 9.1%) (p = 0.03). Requiring urgent or emergent surgery remained a significant predictor of mortality in multivariable analysis (odds ratio 10.4, p = 0.01).
  
  
  CONCLUSIONS
  Pneumonectomy for benign disease has significant risk for mortality, particularly when not performed electively. Although surgery cannot be planned in the setting of trauma or some situations of acute infection, patients known to have conditions that are likely to require pneumonectomy should be considered for surgery earlier in their disease course, before developing an acute problem that requires urgent or emergent resection.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Jacob
authors.initials: J
authors.lastname: Klapper
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Sameer
authors.initials: S
authors.lastname: Hirji
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC. Electronic address: berry037@mc.duke.edu.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult