title: Predictors of Outcome in Modern Surgery for Lung Abscess.
abstract: BackgroundSurgery for lung abscess is a challenging task. Timing and indications for surgery are not well established. Identification of predictors of outcome could help to clarify the role of surgery.MethodsPatients who underwent major thoracic surgery for infectious lung abscess were identified at six centers for general thoracic surgery in Germany, Spain, the United Kingdom, and the United States. Study period was 2000 to 2016.ResultsThere were 91 patients. Pulmonary sepsis (48), pleural empyema (43), persistent air leakage (25), acute renal failure (12), and respiratory failure with mechanical ventilation (25) were already preoperatively present. The mean Charlson index of comorbidity was 3.0 (median: 2.0; interquartile range: 3). Procedures were segmentectomy (18), lobectomy (58), and pneumonectomy (15). The 30-day mortality following surgery was 13/91.Preoperative sepsis (odds ratio [OR]: 13.69; 95% confidence interval [CI]: 1.86-610.53;p< 0.01), preoperative persistent air leak (OR: 13.46, 95% CI: 3.00-85.37,p< 0.01), respiratory failure (OR: 5.60; 95% CI: 1.41-24.84;p< 0.01), acute renal failure (OR: 6.15 ; 95% CI: 1.24-29.56 ;p= 0.01), and Charlson index of comorbidity ≥ 3 (OR: 7.19 ; 95% CI: 1.43-71.21 ;p< 0.01) are associated with higher mortality, whereas age > 70 years (p= 0.46) and the extent of pulmonary resection (segmentectomy, lobectomy, pneumonectomy) have no significant influence on mortality. Patients with fatal outcome have significantly higher Charlson index of comorbidity (p< 0.01).ConclusionsDelayed referral for surgery is common. Significant predictors for fatal outcome are pulmonary sepsis, septic complications (air leak, pleural empyema), septic organ failure (respiratory, acute renal failure), and preexisting comorbidity (Charlson index of comorbidity ≥ 3). The extent of surgical resection shows no significant influence.
authors.affiliation: Department of General and Thoracic Surgery, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schweigert
authors.affiliation: Biometeorology Research Group, University of Veterinary Medicine, Budapest, Hungary.
authors.forename: Norbert
authors.initials: N
authors.lastname: Solymosi
authors.affiliation: Department of Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
authors.forename: Attila
authors.initials: A
authors.lastname: Dubecz
authors.affiliation: Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Joseph
authors.initials: J
authors.lastname: John
authors.affiliation: Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Doug
authors.initials: D
authors.lastname: West
authors.affiliation: Department of General and Thoracic Surgery, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany.
authors.forename: Paul Leonhard
authors.initials: PL
authors.lastname: Boenisch
authors.affiliation: Department of Vascular and Thoracic Surgery, PeaceHealth Southwest Medical Center, Vancouver, Washington, United States.
authors.forename: Riyad
authors.initials: R
authors.lastname: Karmy-Jones
authors.affiliation: Department of Thoracic Surgery, Hospital Universitario Virgen de las Nieves, Granada, Andalucía, Spain.
authors.forename: Carlos F Giraldo
authors.initials: CFG
authors.lastname: Ospina
authors.affiliation: Department of General and Thoracic Surgery, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany.
authors.forename: Ana Beatriz
authors.initials: AB
authors.lastname: Almeida
authors.affiliation: Department of General and Thoracic Surgery, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Witzigmann
authors.affiliation: Department of Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
authors.forename: Hubert J
authors.initials: HJ
authors.lastname: Stein
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D005060:Europe; D005260:Female; D006801:Humans; D008169:Lung Abscess / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States