Emergent pneumonectomy for lung gangrene: Does the outcome warrant the procedure?

Michael Schweigert, Carlos F. Giraldo Ospina, Norbert Solymosi, Riyad Karmy-Jones, Attila Dubecz, Marta Jiménez Fernández, Florencio Quero Valenzuela, Dietmar Ofner, Hubert J. Stein

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Sloughing and gangrene of a complete lung are only very infrequently encountered complications of necrotizing pneumonia and fulminant pulmonary abscess formation. Thus far the role of emergent pneumonectomy is not established. Methods The outcome of patients who underwent anatomic lung resection for lung gangrene at 3 centers for thoracic surgery during the last 13 years was retrospectively analyzed. Only cases of necrotizing pneumonia were included whereas malignant lesions were excluded. Results Overall 44 patients were indentified (average age 56.3 years). Pulmonary sepsis (27 of 44), pleural empyema (29 of 44), persistent air leakage (14 of 44), and respiratory failure with mechanical ventilation (14 of 44) were present preoperatively. The mean Charlson comorbidity index was 2.77. Procedures were segmentectomy (7), lobectomy (26), and pneumonectomy (11). In-hospital mortality was 7 of 44; 2 following pneumonectomy and 5 after lobectomy. In comparing the pneumonectomy group with the lobectomy group we found no significant differences in age (p = 0.59), Charlson comorbidity index (p = 0.18), and postoperative mortality (p = 1). Charlson comorbidity index 3 or greater (odds ratio [OR], 8.41; 95% confidence interval [CI], 0.88 to 421.71; p = 0.04), preoperative pleural empyema (OR, 3.56; 95% CI, 0.37 to 179.62; p = 0.39) and preoperative persistent air leak (OR, 7.34; 95% CI, 1.00 to 89.98; p = 0.02) were associated with higher risk for fatal outcome. Furthermore, patients with sepsis (p = 0.03) and patients sustaining acute renal failure (p = 0.04) had significantly higher mortality. Conclusions Pulmonary sepsis and its complications as well as preexisting comorbidity are the major reasons for fatal outcome, whereas the extent of surgical resection shows no significant influence. Emergent pneumonectomy as ultimate ratio is not only justified but also life saving. Further improvement seems achievable by earlier surgical intervention before the onset of pulmonary sepsis.

Original languageEnglish
Pages (from-to)265-270
Number of pages6
JournalAnnals of Thoracic Surgery
Volume98
Issue number1
DOIs
Publication statusPublished - 2014

Fingerprint

Gangrene
Pneumonectomy
Lung
Comorbidity
Sepsis
Pleural Empyema
Fatal Outcome
Odds Ratio
Confidence Intervals
Air
Lung Abscess
Segmental Mastectomy
Mortality
Hospital Mortality
Artificial Respiration
Acute Kidney Injury
Respiratory Insufficiency
Thoracic Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Schweigert, M., Giraldo Ospina, C. F., Solymosi, N., Karmy-Jones, R., Dubecz, A., Fernández, M. J., ... Stein, H. J. (2014). Emergent pneumonectomy for lung gangrene: Does the outcome warrant the procedure? Annals of Thoracic Surgery, 98(1), 265-270. https://doi.org/10.1016/j.athoracsur.2014.03.007

Emergent pneumonectomy for lung gangrene : Does the outcome warrant the procedure? / Schweigert, Michael; Giraldo Ospina, Carlos F.; Solymosi, Norbert; Karmy-Jones, Riyad; Dubecz, Attila; Fernández, Marta Jiménez; Quero Valenzuela, Florencio; Ofner, Dietmar; Stein, Hubert J.

In: Annals of Thoracic Surgery, Vol. 98, No. 1, 2014, p. 265-270.

Research output: Contribution to journalArticle

Schweigert, M, Giraldo Ospina, CF, Solymosi, N, Karmy-Jones, R, Dubecz, A, Fernández, MJ, Quero Valenzuela, F, Ofner, D & Stein, HJ 2014, 'Emergent pneumonectomy for lung gangrene: Does the outcome warrant the procedure?', Annals of Thoracic Surgery, vol. 98, no. 1, pp. 265-270. https://doi.org/10.1016/j.athoracsur.2014.03.007
Schweigert, Michael ; Giraldo Ospina, Carlos F. ; Solymosi, Norbert ; Karmy-Jones, Riyad ; Dubecz, Attila ; Fernández, Marta Jiménez ; Quero Valenzuela, Florencio ; Ofner, Dietmar ; Stein, Hubert J. / Emergent pneumonectomy for lung gangrene : Does the outcome warrant the procedure?. In: Annals of Thoracic Surgery. 2014 ; Vol. 98, No. 1. pp. 265-270.
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abstract = "Background Sloughing and gangrene of a complete lung are only very infrequently encountered complications of necrotizing pneumonia and fulminant pulmonary abscess formation. Thus far the role of emergent pneumonectomy is not established. Methods The outcome of patients who underwent anatomic lung resection for lung gangrene at 3 centers for thoracic surgery during the last 13 years was retrospectively analyzed. Only cases of necrotizing pneumonia were included whereas malignant lesions were excluded. Results Overall 44 patients were indentified (average age 56.3 years). Pulmonary sepsis (27 of 44), pleural empyema (29 of 44), persistent air leakage (14 of 44), and respiratory failure with mechanical ventilation (14 of 44) were present preoperatively. The mean Charlson comorbidity index was 2.77. Procedures were segmentectomy (7), lobectomy (26), and pneumonectomy (11). In-hospital mortality was 7 of 44; 2 following pneumonectomy and 5 after lobectomy. In comparing the pneumonectomy group with the lobectomy group we found no significant differences in age (p = 0.59), Charlson comorbidity index (p = 0.18), and postoperative mortality (p = 1). Charlson comorbidity index 3 or greater (odds ratio [OR], 8.41; 95{\%} confidence interval [CI], 0.88 to 421.71; p = 0.04), preoperative pleural empyema (OR, 3.56; 95{\%} CI, 0.37 to 179.62; p = 0.39) and preoperative persistent air leak (OR, 7.34; 95{\%} CI, 1.00 to 89.98; p = 0.02) were associated with higher risk for fatal outcome. Furthermore, patients with sepsis (p = 0.03) and patients sustaining acute renal failure (p = 0.04) had significantly higher mortality. Conclusions Pulmonary sepsis and its complications as well as preexisting comorbidity are the major reasons for fatal outcome, whereas the extent of surgical resection shows no significant influence. Emergent pneumonectomy as ultimate ratio is not only justified but also life saving. Further improvement seems achievable by earlier surgical intervention before the onset of pulmonary sepsis.",
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AU - Giraldo Ospina, Carlos F.

AU - Solymosi, Norbert

AU - Karmy-Jones, Riyad

AU - Dubecz, Attila

AU - Fernández, Marta Jiménez

AU - Quero Valenzuela, Florencio

AU - Ofner, Dietmar

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N2 - Background Sloughing and gangrene of a complete lung are only very infrequently encountered complications of necrotizing pneumonia and fulminant pulmonary abscess formation. Thus far the role of emergent pneumonectomy is not established. Methods The outcome of patients who underwent anatomic lung resection for lung gangrene at 3 centers for thoracic surgery during the last 13 years was retrospectively analyzed. Only cases of necrotizing pneumonia were included whereas malignant lesions were excluded. Results Overall 44 patients were indentified (average age 56.3 years). Pulmonary sepsis (27 of 44), pleural empyema (29 of 44), persistent air leakage (14 of 44), and respiratory failure with mechanical ventilation (14 of 44) were present preoperatively. The mean Charlson comorbidity index was 2.77. Procedures were segmentectomy (7), lobectomy (26), and pneumonectomy (11). In-hospital mortality was 7 of 44; 2 following pneumonectomy and 5 after lobectomy. In comparing the pneumonectomy group with the lobectomy group we found no significant differences in age (p = 0.59), Charlson comorbidity index (p = 0.18), and postoperative mortality (p = 1). Charlson comorbidity index 3 or greater (odds ratio [OR], 8.41; 95% confidence interval [CI], 0.88 to 421.71; p = 0.04), preoperative pleural empyema (OR, 3.56; 95% CI, 0.37 to 179.62; p = 0.39) and preoperative persistent air leak (OR, 7.34; 95% CI, 1.00 to 89.98; p = 0.02) were associated with higher risk for fatal outcome. Furthermore, patients with sepsis (p = 0.03) and patients sustaining acute renal failure (p = 0.04) had significantly higher mortality. Conclusions Pulmonary sepsis and its complications as well as preexisting comorbidity are the major reasons for fatal outcome, whereas the extent of surgical resection shows no significant influence. Emergent pneumonectomy as ultimate ratio is not only justified but also life saving. Further improvement seems achievable by earlier surgical intervention before the onset of pulmonary sepsis.

AB - Background Sloughing and gangrene of a complete lung are only very infrequently encountered complications of necrotizing pneumonia and fulminant pulmonary abscess formation. Thus far the role of emergent pneumonectomy is not established. Methods The outcome of patients who underwent anatomic lung resection for lung gangrene at 3 centers for thoracic surgery during the last 13 years was retrospectively analyzed. Only cases of necrotizing pneumonia were included whereas malignant lesions were excluded. Results Overall 44 patients were indentified (average age 56.3 years). Pulmonary sepsis (27 of 44), pleural empyema (29 of 44), persistent air leakage (14 of 44), and respiratory failure with mechanical ventilation (14 of 44) were present preoperatively. The mean Charlson comorbidity index was 2.77. Procedures were segmentectomy (7), lobectomy (26), and pneumonectomy (11). In-hospital mortality was 7 of 44; 2 following pneumonectomy and 5 after lobectomy. In comparing the pneumonectomy group with the lobectomy group we found no significant differences in age (p = 0.59), Charlson comorbidity index (p = 0.18), and postoperative mortality (p = 1). Charlson comorbidity index 3 or greater (odds ratio [OR], 8.41; 95% confidence interval [CI], 0.88 to 421.71; p = 0.04), preoperative pleural empyema (OR, 3.56; 95% CI, 0.37 to 179.62; p = 0.39) and preoperative persistent air leak (OR, 7.34; 95% CI, 1.00 to 89.98; p = 0.02) were associated with higher risk for fatal outcome. Furthermore, patients with sepsis (p = 0.03) and patients sustaining acute renal failure (p = 0.04) had significantly higher mortality. Conclusions Pulmonary sepsis and its complications as well as preexisting comorbidity are the major reasons for fatal outcome, whereas the extent of surgical resection shows no significant influence. Emergent pneumonectomy as ultimate ratio is not only justified but also life saving. Further improvement seems achievable by earlier surgical intervention before the onset of pulmonary sepsis.

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