Published ahead of print on February 10, 2006, doi:10.1164/rccm.200510-1556OC
Am. J. Respir. Crit. Care Med., Volume 173, Number 10, May 2006, 1161-1169
A more recent version of this article appeared on May 15, 2006
Submitted on October 3, 2005
Accepted on February 10, 2006
Postoperative Pneumonia After Major Lung Resection
Olivier Schussler1*, Marco Alifano1, Herve Dermine2, Salvatore Strano1, Anne Casetta3, Sergio Sepulveda2, Aziz Chafik1, Sophie Coignard3, Antoine Rabbat4, and Jean Francois Regnard1
1 Department of Thoracic Surgery, Hotel-Dieu Hospital, Paris, France,
2 Department of Intensive Care Medicine, Hotel-Dieu Hospital, Paris, France; Department of Anaesthesia, Hotel-Dieu Hospital, Paris, France,
3 Department of Microbiology, Hotel-Dieu Hospital, Paris, France,
4 Department of Intensive Care Medicine, Hotel-Dieu Hospital, Paris, France; Department of Pneumology, Hotel-Dieu Hospital, Paris, France
* To whom correspondence should be addressed. E-mail: marcoalifano{at}yahoo.com.
Background: Postoperative pneumonia is a life threatening complication of lung resection. The incidence, causative bacteria, predisposing factors, and outcome are poorly known.
Design: Prospective observational study.
Methods: A prospective study on all patients undergoing major lung resections for non-infectious disease was performed during a 6-month period. Culture of intra-operative bronchial aspirates was systematically performed. All the patients with suspicion of pneumonia underwent bronchoscopic sampling and culture before antibiotherapy.
Results: One-hundred-sixty-eight patients were included in the study. Bronchial colonization was identified in 31/136 cases (22.8%) upon intraoperative samples. The incidence of postoperative pneumonia was 25% (42/168). Microbiologically documented and not-documented pneumonias were recorded in 24 and 18 cases, respectively. Haemophilus sp, Streptococcus sp., and, at a much lesser extent, Pseudomonas sp., and Serratia sp. were the most frequent pathogens. Among colonized and non-colonized patients, postoperative pneumonia occurred in 15/31 and 20/105 cases respectively (p=0.0010, RR=2.54). Death occurred in 8 out of 42 patients who developed a POP and in 3/126 of patients who did not (p=0.0012). Patients with POP required non-invasive ventilation or re-intubation more frequently than patients who did not develop POP (p<0.0000001 and p=0.00075, respectively). POP was associated with longer ICU and hospital stay (p<0.0000001 and p=0.0000005, respectively). Multivariate analysis showed that COPD, extent of resection, presence of intraoperative bronchial colonization and male sex were independent risk factors for POP.
Conclusions: In-hospital acquired pneumonia represents a relatively frequent complication of lung resections, associated with an important percentage of postoperative morbidity and mortality.
Key words: postoperative pneumonia, lung resection, risk factors, colonization, thoracic surgery.
This article has been cited by other articles:
|
|
|
|
 
O. Schussler, H. Dermine, M. Alifano, N. Roche, S. Strano, A. Casetta, A. Meunier, S. Coignard, M. Salvi, P. Magdeleinat, et al.
Reply
Ann. Thorac. Surg.,
September 1, 2009;
88(3):
1052 - 1052.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Alifano, G. Cusumano, S. Strano, P. Magdeleinat, A. Bobbio, F. Giraud, B. Lebeau, and J.-F. Regnard
Lobectomy with pulmonary artery resection: Morbidity, mortality, and long-term survival.
J. Thorac. Cardiovasc. Surg.,
June 1, 2009;
137(6):
1400 - 1405.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Bryant and R. J. Cerfolio
The analysis of a prospective surgical database improves postoperative fast-tracking algorithms after pulmonary resection.
J. Thorac. Cardiovasc. Surg.,
May 1, 2009;
137(5):
1173 - 1179.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Schussler, H. Dermine, M. Alifano, A. Casetta, S. Coignard, N. Roche, S. Strano, A. Meunier, M. Salvi, P. Magdeleinat, et al.
Should We Change Antibiotic Prophylaxis for Lung Surgery? Postoperative Pneumonia Is the Critical Issue
Ann. Thorac. Surg.,
December 1, 2008;
86(6):
1727 - 1733.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Shimizu, M. Nakata, Y. Hirami, A. Maeda, and K. Tanemoto
Recent results regarding the clinical impact of smoking history on postoperative complications in lung cancer patients
Interactive CardioVascular and Thoracic Surgery,
December 1, 2008;
7(6):
1001 - 1006.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Giovannetti, M. Alifano, A. Stefani, A. Legras, M. Grigoroiu, J.-Y. Collet, P. Magdelenat, and J.-F. Regnard
Surgical treatment of bronchiectasis: early and long-term results
Interactive CardioVascular and Thoracic Surgery,
August 1, 2008;
7(4):
609 - 612.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Alifano, M. S. Boudaya, M. Salvi, J.-Y. Collet, C. Dinu, S. Camilleri-Broet, and J.-F. Regnard
Pneumonectomy After Chemotherapy: Morbidity, Mortality, and Long-Term Outcome
Ann. Thorac. Surg.,
June 1, 2008;
85(6):
1866 - 1873.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Ligabue, L. Voltolini, C. Ghiribelli, L. Luzzi, C. Rapicetta, and G. Gotti
Abscess of Residual Lobe After Pulmonary Resection for Lung Cancer
Asian Cardiovasc Thorac Ann,
April 1, 2008;
16(2):
112 - 114.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
X. B. D'Journo, P. Michelet, L. Papazian, M. Reynaud-Gaubert, C. Doddoli, R. Giudicelli, P. A. Fuentes, and P. A. Thomas
Airway colonisation and postoperative pulmonary complications after neoadjuvant therapy for oesophageal cancer
Eur. J. Cardiothorac. Surg.,
March 1, 2008;
33(3):
444 - 450.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Radu, F. Jaureguy, A. Seguin, C. Foulon, M. D. Destable, J. Azorin, and E. Martinod
Postoperative Pneumonia After Major Pulmonary Resections: An Unsolved Problem in Thoracic Surgery
Ann. Thorac. Surg.,
November 1, 2007;
84(5):
1669 - 1673.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Dubey and C. A. Powell
Update in Lung Cancer 2006
Am. J. Respir. Crit. Care Med.,
May 1, 2007;
175(9):
868 - 874.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. B. Milbrandt, A. Ishizaka, and D. C. Angus
Update in Critical Care 2006
Am. J. Respir. Crit. Care Med.,
April 1, 2007;
175(7):
638 - 648.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Hoksch, R. Fahrner, and R. Alexander Schmid
Procalcitonin and brain natriuretic peptide as parameters in the postoperative course of patients with major pulmonary resection
Interactive CardioVascular and Thoracic Surgery,
April 1, 2007;
6(2):
155 - 159.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Bobbio, D. Caporale, E. Internullo, L. Ampollini, S. Bettati, E. Rossini, P. Carbognani, and M. Rusca
Postoperative outcome of patients undergoing lung resection presenting with new-onset atrial fibrillation managed by amiodarone or diltiazem
Eur. J. Cardiothorac. Surg.,
January 1, 2007;
31(1):
70 - 74.
[Abstract]
[Full Text]
[PDF]
|
|
|
Copyright © 2006 American Thoracic Society
|
|
|
