Predisposing factors of atelectasis following pulmonary lobectomy.

BACKGROUND

The aims of our study were to investigate postoperative atelectasis complicating pulmonary lobectomy, identify risk factors and evaluate its relationship to other postoperative complications.

MATERIAL AND

METHODS

From January 2004 to April 2007, 412 patients underwent pulmonary lobectomy. We performed a retrospective analysis of our prospective database. Post-lobectomy atelectasis (PLA) was defined as an ipsilateral opacification of the remaining lobe with an ipsilateral shift of the mediastinum on the chest radiography, requiring bronchoscopy.

RESULTS

The incidence of PLA was 6.6%, comprising 29% of all postoperative pulmonary complications seen. There was no statistically significant difference in patient age, gender, ASA score, cardiovascular co-morbidity or operation time for the PLA group versus the group without this complication. Current smokers were at a higher risk for PLA, but this incidence did not reach statistical significance. Chronic obstructive pulmonary disease (COPD) was the only preoperative variable increasing the risk of PLA (p < 0.05). Patients undergoing a right upper lobectomy, either on its own or in combination with a right middle lobe resection, had a significantly higher incidence of PLA when compared with all other types of resection (p < 0.05).

CONCLUSIONS

Patients with COPD and those undergoing right upper lobe resection have an increased risk of PLA. In this group of patients we should use pre-operative (cessation of cigarette smoking, treatment of airflow obstruction in patients with COPD), intra-operative (duration of operation) and postoperative (intensive physiotherapy and effective postoperative pain control) measures to decrease the risk of PLA. Although often solitary, PLA is associated with a longer hospital stay.