Risk factors for bronchopleural fistula based on surgical procedure and sex in 4794 consecutive patients undergoing anatomical pulmonary resection,Surgery Today

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Risk factors for bronchopleural fistula based on surgical procedure and sex in 4794 consecutive patients undergoing anatomical pulmonary resection
Surgery Today ( IF 1.7 ) Pub Date : 2023-11-04 , DOI: 10.1007/s00595-023-02761-2
Takeshi Matsunaga ₁ , Kenji Suzuki ₁ , Aritoshi Hattori ₁ , Mariko Fukui ₁ , Kazuya Takamochi ₁

Affiliation

Purpose

Bronchopleural fistula (BPF) is a lethal complication, even in the modern era. Therefore, we investigated the details of patients with BPF to select an appropriate surgical strategy.

Methods

This retrospective study included 4794 consecutive patients who underwent anatomical pulmonary resection between 2008 and 2022. We evaluated the predictors of BPF using a multivariable analysis and investigated the mortality and clinical course after BPF in detail.

Results

BPF was observed in 32 patients (0.67%). In the multivariable analysis, the predictors for BPF were male sex (odds ratio [OR], 6.91), the body mass index (OR, 2.40), the vital capacity (%VC) (OR, 2.93), surgery performed (right lower lobectomy [OR, 10.92], right middle and lower lobectomy [OR, 6.97], and right pneumonectomy [OR, 16.68]), and additional resection of surrounding organs (OR, 3.47). Among the risk factors, surgery performed and male sex were very strong risk factors, with the frequency itself very low in females (0.1%). The 90-day mortality was 15.6%, and the 5-year overall survival in patients with BPF was 28.1%.

Conclusion

Our study revealed that independent risk factors and consideration of the surgical methods and sex might help determine whether or not special attention should be given to the bronchial stump, which will be of great help in surgical strategies.

中文翻译：

基于手术方式和性别的 4794 例连续接受解剖性肺切除术患者的支气管胸膜瘘危险因素

目的

即使在现代，支气管胸膜瘘（BPF）也是一种致命的并发症。因此，我们调查了 BPF 患者的详细信息，以选择合适的手术策略。

方法

这项回顾性研究纳入了 2008 年至 2022 年间接受解剖性肺切除术的 4794 名连续患者。我们使用多变量分析评估了 BPF 的预测因素，并详细调查了 BPF 后的死亡率和临床病程。

结果

32 名患者（0.67%）观察到 BPF。在多变量分析中，BPF 的预测因素为男性（比值比 [OR]，6.91）、体重指数（OR，2.40）、肺活量（%VC）（OR，2.93）、进行的手术（右下肺叶切除术[OR，10.92]、右中下叶切除术[OR，6.97]和右全肺切除术[OR，16.68]），以及周围器官的额外切除术（OR，3.47）。在危险因素中，手术和男性是很强的危险因素，而女性的发生频率很低（0.1%）。 BPF 患者的 90 天死亡率为 15.6%，5 年总生存率为 28.1%。