Impact of Delayed Chest Closure on Surgical Site Infection After Lung Transplantation

Aguilar, Patrick R.; Bemiss, B.; Witt, Chad A.; Byers, Derek E.; Kreisel, Daniel; Meyers, Bryan F.; Patterson, G. Alexander; Krupnick, Alexander S.; Yusen, Roger D.; Trulock, Elbert P.; Hachem, Ramsey R.

doi:10.1016/j.athoracsur.2017.05.023

Cited by 17 publications

(40 citation statements)

References 19 publications

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“…Additionally, this is the first study regarding this topic in Latin America. 3,8,10 Risk factors related to the occurrence of SSI found in this study were the recipients' BMI, prolonged surgery time, duration of chest tube placement, donor smoking status, and positive donors BALs. Multidrug-resistant organisms (MDROs) were frequently identified in the SSI group.…”

Section: Discussionmentioning

confidence: 74%

“…Additionally, SSI could result in other adverse consequences, such as extended hospital stays, increased rates of rehospitalization, prolonged time away from work, family and social commitments, and excess utilization of health care resources. [5][6][7][8] The incidence of SSI is variable, with previous studies reporting rates ranging from 5% to 15%, depending on the recipients and surgical characteristics. 3,[8][9][10] Also, detection of SSI among this specific population is difficult due to the use of immunosuppression, such that the signs and symptoms of SSI, including fever, purulent discharge, and erythema, could be unremarkable or absent.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8] The incidence of SSI is variable, with previous studies reporting rates ranging from 5% to 15%, depending on the recipients and surgical characteristics. 3,[8][9][10] Also, detection of SSI among this specific population is difficult due to the use of immunosuppression, such that the signs and symptoms of SSI, including fever, purulent discharge, and erythema, could be unremarkable or absent. 11 Several risk factors related to patient and procedure characteristics have been described in the literature on thoracic surgery, such as diabetes mellitus, hyperglycemia, perioperative hypothermia, obesity, prolonged surgery time, and transfusion of red blood cells.…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Lung Transplant

et al. 2020

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Background: Surgical site infections (SSIs) are among the leading health care–associated infections as well as a major problem in the postoperative period of lung transplant recipients. Little is known about the risk factors in this specific population. The objective of this study was to identify the incidence, risk factors, and outcomes of SSI following lung transplant. Methods: Digital medical records of adult recipients subjected to lung transplant from July 2011 and June 2016 in a large Brazilian referral teaching public center were analyzed in this retrospective cohort follow-up. Results: Among the 121 recipients analyzed, 19 (15.7%) had SSI; of these, 11 (57.8%) had superficial incisional infections, 1 (5.2%) had a deep incisional infection, and 7 (36.8%) had organ/space infection. Recipient-related risk factors for SSI were high body mass index ( P = .041), prolonged surgery time ( P = .043), and prolonged duration of chest drain placement ( P = .009). At the multiple logistic regression was found that each hour elapsed in the surgical time increased the odds of SSI by around 2 times (odds ratio 2.34; 95% CI, 1.46-4.53; P = .002). Donor-related risk factors included smoking status ( P = .05) and positive bronchoalveolar lavage ( P < .001). Having an SSI was associated with an increased length of stay in intensive care units ( P = .003), reoperation ( P = .014), and a higher 1-year mortality rate ( P = .02). Conclusions: The identified incidence rate was higher to that observed in the previous studies. The risk factors duration of chest tube placement and donor smoking status are different from those reported in the scientific literature.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Lung Transplant

et al. 2020

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“…In addition, the native upper lobes should be compared to the lower lobes on computed tomography or perfusion scintigraphy. Surgical lung resection [18,19], delayed thoracic closure [20,21], or single lung/lobe transplantation [17], can be performed to match size when an excessively large donor lung is present. The most common procedure is a wedge resection.…”

Section: Management Of a Size Mismatch In Lung Transplantationmentioning

confidence: 99%

“…This process is regarded as delayed chest closure, and its results are quite successful and functional. However, this process has been reported to cause a substantial increase in the frequency of wound infections [21].…”

Section: Management Of a Size Mismatch In Lung Transplantationmentioning

confidence: 99%

Size matching in lung transplantation: A narrative review

Apaydin¹,

Yeginsu²

2020

Arch Organ Transplant

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The risks of primary graft dysfunction, additional airway complications (due to a bronchial diameter mismatch), persistent pleural effusion, infection, hyperinfl ation of the lung, elevated risk of operative bleeding, greater acute lung injury (due to higher tidal volume during mechanical ventilation), and the development of greater pulmonary vascular resistance are higher in cases involving extremely small donor lungs [2,3]. AbstractBackground: Size matching between donor lungs and recipient chest space is an important technical problem that affects the outcome and survival following lung transplantation. The size of the lung can vary according to underlying disease, previous resections, and ethnicity, as well as height, age, and sex. Measurements of predicted total lung capacity according to height, age, and sex are frequently used, although other measurement methods are available. Result:Excessively large or small donor lungs are undesirable for lung transplantation because they cause complications. In general, post-transplant outcomes are better when the donor lung is reasonably larger than the recipient thoracic cavity. However, larger donor lungs are not recommended for recipients with emphysema. We performed a literature search using Medline/PubMed, the Cochrane Library Database, and Scielo to identify articles published between June 2016 and July 2018 related to the effect of lung size matching on the prognosis of lung transplant patients. The literature primarily provides information regarding double lung transplantation with a predicted total lung capacity for the donor of 75%-125% of the predicted recipient total lung capacity. Data are lacking with respect to the size mismatch for single lung transplantation and recipients with restrictive pulmonary disorders. Conclusion:This review presents detailed fi ndings regarding size matching in lung transplantation.

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Long-term survival and clinical outcomes of delayed chest closure following lung transplantation

Hirama,

Akiba,

et al. 2024

Surg Today

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Purposes Delayed chest closure (DCC) is a widely accepted procedure in the context of lung transplantation (LTx); yet there are few reports detailing its long-term survival and clinical outcomes. Methods We reviewed the medical records of recipients who underwent deceased-donor lung transplantation (LTx) at Tohoku University Hospital. Long-term survival, including overall survival, freedom from chronic lung allograft dysfunction (CLAD), and CLAD-free survival and the clinical outcomes of graft function and physical performance and constitution were reviewed in recipients with DCC. Results Between 2009 and 2022, 116 patients underwent LTx, 33 of whom (28.4%) required DCC. The intra—and post-operative courses of the recipients who required DCC were more complicated than those of the recipients who underwent primary chest closure (PCC), with frequent volume reduction surgery and longer periods of invasive mechanical ventilation. Pulmonary vascular disease was considered a risk factor for these complications and DCC. Nonetheless, long-term survival and graft functions were comparable between the DCC and PCC groups. The physical performance and constitution of recipients who required DCC continued to improve, and by 2 years after transplantation, exhibited almost no difference from those who underwent PCC. Conclusions In view of the profoundly complicated intra- and post-operative courses, DCC should be performed cautiously and only when clinically indicated, despite which it can result in equivalent long-term survival and acceptable outcomes to PCC.

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Impact of Delayed Chest Closure on Surgical Site Infection After Lung Transplantation

Cited by 17 publications

References 19 publications

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Lung Transplant

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Lung Transplant

Size matching in lung transplantation: A narrative review

Long-term survival and clinical outcomes of delayed chest closure following lung transplantation

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