PNEUMONECTOMY FOR CHRONIC INFECTION IS A HIGH-RISK PROCEDURE

Background. The purpose of this study was to estimate operative risk, and to identify indicators of adverse prognosis, in patients undergoin g pneumonectomy for chronic infection. Methods. Twenty-five patients a ged 41 +/- 15 years underwent pneumonectomy (three completions) for ch ronic infection: sequelae of tuberculosis, 15; cystic bronchiectasis, 9; and radiation pneumonitis, 1. Eight patients had aspergilloma (7 af ter tuberculosis, 1 with radiation pneumonitis). Results. Operative mo rtality was 4%. Operative blood loss was estimated at 1,983 +/- 1,424 mL, ranging from 150 to 5,600 mL. A single patient required reexplorat ion. Eight patients (32%) had empyema, and a further 3 (12%) had bronc hopleural fistula; thoracoplasty was required for 10 (40%). Sequelae o f tuberculosis heralded increased operative bleeding (t = 2.884; p < 0 .005). Incidence of empyema or bronchopleural fistula was increased in patients with sequelae of tuberculosis (chi(2) = 3.896; p < 0.05), pa tients with aspergilloma (chi(2) = 4.588; p < 0.05), patients in whom the parenchymal cavities were entered (chi(2) = 11.5; p < 0.001), and those in whom blood loss was in excess of 1,000 mL (chi(2) = 4.911; p < 0.05). Conclusions. We conclude that pneumonectomy is a high-risk pr ocedure, especially in patients with sequelae of tuberculosis.