Predictors of Outcome in Modern Surgery for Lung Abscess

Michael Schweigert, N. Solymosi, Attila Dubecz, Joseph John, Doug West, Paul Leonhard Boenisch, Riyad Karmy-Jones, Carlos F Giraldo Ospina, Ana Beatriz Almeida, Helmut Witzigmann, Hubert J. Stein

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish
JournalThoracic and Cardiovascular Surgeon
DOIs
Publication statusAccepted/In press - Dec 19 2016

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Lung Abscess
Comorbidity
Pleural Empyema
Sepsis
Fatal Outcome
Segmental Mastectomy
Pneumonectomy
Acute Kidney Injury
Respiratory Insufficiency
Lung
Thoracic Surgery
Air
Mortality
Artificial Respiration
Spain
Germany
Referral and Consultation
Odds Ratio
Confidence Intervals

Keywords

  • lung abscess
  • pulmonary infection
  • sepsis

ASJC Scopus subject areas

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

Cite this

Schweigert, M., Solymosi, N., Dubecz, A., John, J., West, D., Boenisch, P. L., ... Stein, H. J. (Accepted/In press). Predictors of Outcome in Modern Surgery for Lung Abscess. Thoracic and Cardiovascular Surgeon. https://doi.org/10.1055/s-0037-1598113

Predictors of Outcome in Modern Surgery for Lung Abscess. / Schweigert, Michael; Solymosi, N.; Dubecz, Attila; John, Joseph; West, Doug; Boenisch, Paul Leonhard; Karmy-Jones, Riyad; Ospina, Carlos F Giraldo; Almeida, Ana Beatriz; Witzigmann, Helmut; Stein, Hubert J.

In: Thoracic and Cardiovascular Surgeon, 19.12.2016.

Research output: Contribution to journalArticle

Schweigert, M, Solymosi, N, Dubecz, A, John, J, West, D, Boenisch, PL, Karmy-Jones, R, Ospina, CFG, Almeida, AB, Witzigmann, H & Stein, HJ 2016, 'Predictors of Outcome in Modern Surgery for Lung Abscess', Thoracic and Cardiovascular Surgeon. https://doi.org/10.1055/s-0037-1598113
Schweigert, Michael ; Solymosi, N. ; Dubecz, Attila ; John, Joseph ; West, Doug ; Boenisch, Paul Leonhard ; Karmy-Jones, Riyad ; Ospina, Carlos F Giraldo ; Almeida, Ana Beatriz ; Witzigmann, Helmut ; Stein, Hubert J. / Predictors of Outcome in Modern Surgery for Lung Abscess. In: Thoracic and Cardiovascular Surgeon. 2016.
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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.",
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AU - Schweigert, Michael

AU - Solymosi, N.

AU - Dubecz, Attila

AU - John, Joseph

AU - West, Doug

AU - Boenisch, Paul Leonhard

AU - Karmy-Jones, Riyad

AU - Ospina, Carlos F Giraldo

AU - Almeida, Ana Beatriz

AU - Witzigmann, Helmut

AU - Stein, Hubert J.

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N2 - 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.

AB - 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.

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