Author of

• 32243

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  EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)

  • Event: WCLC 2019
  • Type: E-Poster Viewing in the Exhibit Hall
  • Track: Treatment in the Real World - Support, Survivorship, Systems Research
  • Presentations: 1
  • Now Available
  • Moderators:
  • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall

  • 32273

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    EP1.16-29 - Clinical Characteristics and Outcomes of Postoperative Empyema Following Lung Surgery (Now Available) (ID 1645)

    08:00 - 18:00  |  Presenting Author(s): Kenji Kameyama
    • Abstract
    • Slides

    Background
    

    Postoperative empyema prolongs hospital-stay durations and may lead to mortality. However, clinical risk factors for postoperative empyema have been insufficiently investigated. This study explored the relevant characteristics and outcomes of postoperative empyema after lung surgery.

    Method
    

    A retrospective study of 16 cases of postoperative empyema after lung surgery between April 2008 and December 2018 was conducted. The inclusion criteria were patients who had fever and bacterial pleural effusion confirmed by culture within the first 30 postoperative days. Preoperative patient characteristics, operative findings, and postoperative course were evaluated.

    Result
    

    There were eight cases of empyema with fistula (six with pulmonary fistula and two with bronchopleural fistula) and eight without fistula. Patients included 15 men and one woman. Median (range) age, body mass index, and Brinkman index were 68 (20-84) years, 22.9 (14.5-27) kg/m², and 650 (0-2320), respectively. Nine patients were operatively diagnosed with primary lung cancer (p-stage I, three cases; p-stage ≥II, six), six with metastatic lung cancer, and one with pneumothorax. Co-morbidities included chronic obstructive pulmonary disease (COPD) (eight cases; incidence, 50%); diabetes mellitus (five cases; 31%), and history of preoperative chemotherapy (seven cases; 44%). Operative procedures were as follows: two pneumonectomies, five lobectomies, two segmentectomies, six wedge resections, and one bulla suturing. Surgical approaches included 12 thoracoscopic surgeries and four open thoracotomies. Median (range) operative time and bleeding volume was 219 (92-739) minutes and 21 (0-1400) g, respectively. Surgery-to-empyema-onset duration was 12 (4-30) days. Before empyema onset, postoperative complications developed in 14 cases (88%) as follows: four, surgical-site infection; four, prolonged pulmonary air leak; two, pneumonia; two, bronchopleural fistula; one, both prolonged pulmonary air leak and surgical-site infection; and one, both pneumonia and surgical-site infection. Organisms cultured from empyema cases included Staphylococcus aureus (12 cases; MRSA, one), oral resident bacteria (three), and others (one). Postoperatively, five cases required treatment with antibiotics only; five, both antibiotics and chest drainage; and six, surgery with the aforementioned treatments. Surgical procedures for empyema included thoracoscopic debridement and/or pleural irrigation (four cases) and fenestration (two cases). The hospital-stay duration after first surgery was 30 (12-99) days. There were no postoperative mortalities.

    Conclusion
    

    Diabetes mellitus, preoperative chemotherapy, and COPD could be significant risk factors for postoperative empyema. Infecting organisms associated with postoperative empyema were related to preceding postoperative complications. Therefore, emphasis on controlling factors that contribute to pulmonary and surgical-site infection and pulmonary air leak is important to prevent postoperative empyema.

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