Analysis of risk factors in the development of bronchopleural fistula after major anatomic lung resection: experience of a single centre

The role of low-dose glucocorticoids in preventing bronchopleural fistula after bronchoplasty: a retrospective study

OBJECTIVES

The aim of this study was to evaluate the clinical significance of early administration of low-dose corticosteroids after bronchoplasty, for the prevention of bronchopleural fistula (BPF).

METHODS

A total of 356 patients who underwent bronchoplasty in our hospital from 2019 to 2023 were retrospectively included. Univariate and multivariate logistic regression methods were used to determine the factors affecting the occurrence of BPF, and the significant factors were screened for Receiver Operating Characteristics (ROC) curves.

RESULTS

A total of 356 patients who underwent bronchoplasty were included in this study, 12 of whom developed BPF. Univariate and multivariate logistic regression analysis results showed that Preoperative serum albumin level (odds ratio (OR) = 0.64, 95% confidence interval (CI): 0.52-0.78, P < 0.01), low-dose glucocorticoid (OR = 0.11, 95% CI: 0.01-0.89, P = 0.038) were significant factors affecting postoperative BPF. Subsequently, the ROC curves of glucocorticoid and preoperative serum albumin level affecting the occurrence of BPF showed that low-dose glucocorticoids and preoperative albumin level were significantly correlated with the occurrence of BPF [Area Under Curves (AUC) = 0.681, AUC = 0.860], and the model had good prediction accuracy.

CONCLUSIONS

Early use of low-dose glucocorticoids after bronchoplasty was associated with a reduced incidence of BPF, suggesting a potential role in preventing this complication. Preoperative serum albumin levels were identified as an independent risk factor for BPF, and it is recommended that a comprehensive assessment of the patient's nutritional status, including but not limited to serum albumin levels, be performed during preoperative management to optimize preoperative management and reduce the occurrence of BPF.

THE USE OF FIBRIN GLUE IN THE TREATMENT OF BRONCHIAL STUMP FAILURE AFTER LOWER LOBECTOMY ON THE RIGHT (A CLINICAL CASE)

Despite the constantly improving technique of operations, the use of modern suture materials and stitching-cutting devices, the problem of the occurrence of the failure of the bronchial stump remains unresolved. Many methods have been proposed for the treatment of bronchial stump failure, ranging from endoscopic mucosal coagulation and the installation of various types of occluders and ending with repeated surgical interventions. There are a huge number of publications devoted to the use of fibrin glue in various fields of medicine, for example, in neurosurgery, maxillofacial surgery, orthopedics, dentistry and thoracic surgery, fibrin glue is successfully used, including in the development of bronchial stump failure. This article presents a clinical observation of the use of fibrin glue in the treatment of bronchial stump failure after lower lobectomy on the right.

Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy)

The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.

Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy)

The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.