Thorac cardiovasc Surg 2017; 65(07): 535-541
DOI: 10.1055/s-0037-1598113
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Predictors of Outcome in Modern Surgery for Lung Abscess

Michael Schweigert1, Norbert Solymosi2, Attila Dubecz3, Joseph John4, Doug West4, Paul Leonhard Boenisch1, Riyad Karmy-Jones5, Carlos F. Giraldo Ospina6, Ana Beatriz Almeida1, Helmut Witzigmann1, Hubert J. Stein3
  • 1Department of General and Thoracic Surgery, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany
  • 2Biometeorology Research Group, University of Veterinary Medicine, Budapest, Hungary
  • 3Department of Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
  • 4Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
  • 5Department of Vascular and Thoracic Surgery, PeaceHealth Southwest Medical Center, Vancouver, Washington, United States
  • 6Department of Thoracic Surgery, Hospital Universitario Virgen de las Nieves, Granada, Andalucía, Spain
Further Information

Publication History

05 October 2016

19 December 2016

Publication Date:
01 March 2017 (eFirst)

Abstract

Background Surgery 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.

Methods Patients 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.

Results There 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).

Conclusions Delayed 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.

Funding

None.


Note

Presented as oral presentation at the SCTS Annual Meeting & Cardiothoracic Forum, Birmingham, March 13–15, 2016.