Elsevier

The Annals of Thoracic Surgery

Volume 88, Issue 5, November 2009, Pages 1556-1565
The Annals of Thoracic Surgery

Original article
General thoracic
Surgical Lung Resection for Severe Hemoptysis

https://doi.org/10.1016/j.athoracsur.2009.06.011Get rights and content

Background

The role of surgical lung resection in the management of severe hemoptysis has evolved after advances in interventional radiology. We sought to describe the indications for surgical lung resection in such patients and to identify predictive factors of postoperative complications.

Methods

This study is a retrospective analysis (May 1995 to July 2006) of consecutive patients referred to the intensive care unit of a tertiary hospital for severe hemoptysis who underwent surgical lung resection.

Results

Among 813 patients referred for severe hemoptysis, 111 underwent surgical lung resection. Interventional radiology had been first attempted in 87 patients (78%); 68 underwent surgery because of a failed procedure (n = 28) or bleeding persistence or recurrence within 72 hours despite a completed procedure (n = 40); 19 patients underwent surgery after bleeding control. The remaining 24 patients (22%) were directly referred to the surgeon (5 for emergency surgery). Overall, surgery was performed in emergency (n = 48), scheduled after bleeding control (n = 48), or planned after discharge (n = 15). The main indications for surgery were mycetoma, cancer, bronchiectasis, and active tuberculosis. Surgery for mycetoma (odds ratio, 9.4; 95% confidence interval, 2.8 to 32), emergency surgery (odds ratio, 5.3; 95% confidence interval, 1.8 to 16), and pneumonectomy (odds ratio, 4.7; 95% confidence interval, 1.2 to 18) independently predicted complications. Fifteen patients died in the intensive care unit, of whom 14 underwent emergency surgery. Chronic alcoholism (odds ratio, 4.6; 95% confidence interval, 1.1 to 19), the need for mechanical ventilation or vasoactive drugs on admission (odds ratio, 8.2; 95% confidence interval, 1.9 to 35), and blood transfusion before surgery (odds ratio, 8; 95% confidence interval, 1.5 to 42) predicted mortality.

Conclusions

Attempting at controlling bleeding with first-line nonsurgical approaches appears necessary to optimize the operative conditions and improve outcome of patients with severe hemoptysis.

Section snippets

Patients

The study was conducted during an 11-year period (May 1995 to July 2006) at Tenon Hospital, a tertiary university hospital and referral center for hemoptysis in Paris, France. All consecutive patients admitted to our institution with SH who underwent surgical lung resection were eligible. Patients with hemoptysis who underwent a diagnostic open lung biopsy were excluded. For each patient, baseline demographics, comorbid conditions, initial clinical presentation and vital signs, cause of

Results

During the 11-year study period, 813 consecutive patients were referred to our unit for SH, of whom 116 (14%) underwent a surgical lung resection. Five patients were excluded from the analysis (diagnostic surgical lung biopsy, n = 2; surgery planned 6 months after the initial episode of hemoptysis, n = 2; and surgery performed at another center, n = 1). Overall, 111 patients undergoing surgical resection for SH in our center were analyzed. Some of these patients have been described elsewhere [11

Comment

We investigated the role of surgery in the management of a large series of patients referred for SH in the era of interventional radiology. Surgery was indicated in about 14% of patients, with emergency surgery representing nearly half of the procedures, mostly after failed attempt or unsuccessful interventional radiology. A similar proportion underwent scheduled surgery during the same hospital admission, after bleeding was controlled using general supportive care alone or combined with

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