Risk Factors for Postoperative Pulmonary Complications Leading to Increased Morbidity and Mortality in Patients Undergoing Thoracic Surgery for Pleural Empyema

Objectives: Surgery for pleural empyema carries a high burden of morbidity and mortality. The authors investigated the incidence of postopera-tive pulmonary complications (PPCs) and their effects on perioperative morbidity and mortality. Patient-specific, preoperative, procedural, and postoperative risk factors for PPCs were analyzed.Design: Retrospective observational study.Setting: A single, large university hospital.Participants: A total of 250 adult patients were included who underwent thoracic surgery for pleural empyema between January 2017 and December 2021.Interventions: None.Measurements and Main Results: A total of 250 patients with pleural empyema underwent thoracic surgery by video-assisted thoracoscopic sur-gery (49%; n = 122) or open thoracotomy (51%; n = 128). A proportion (42% [105]) of patients had >1 PPCs; 28% (n = 70) had to undergo resur-gery; and 10% (n = 25) were re-admitted unexpectedly to the ICU. Preoperative respiratory failure (odds ratio [OR]: 5.8, 95% CI: 2.4-13.1), general anesthesia without regional analgesia techniques (OR: 2.9, 95% CI: 1.4-5.8), open thoracotomy and subsequent resurgery (OR: 3.9, 95% CI 1.5-9.9), surgery outside the regular working hours (OR: 3.1, 95% CI 1.2-8.2), and postoperative sepsis (OR: 2.6, 95% CI 1.1-6.8) were identi-fied as independent risk factors for PPCs. Postoperative pulmonary complications were independent factors for unplanned intensive care unit admission (OR: 10.5, 95% CI 2.1-51 for >1 PPC), death within 360 days (OR: 4.5, 95% CI 2.2-12.3 for >2 PPCs), and death within 30 days for >1 PPCs (OR: 1.2, 95% CI 1.1-1.3).Conclusions: The incidence of PPCs is a significant risk factor for morbidity and mortality after surgery for pleural empyema. Targeting the risk factors identified in this study could improve patient outcomes.& COPY; 2023 Elsevier Inc. All rights reserved.