Surgical resection for patients with pulmonary aspergillosis in the national inpatient sample

Abstract

Background: The role of lung resection in patients with pulmonary aspergillosis is generally reserved for those with localized disease who fail medical management. We used a national database to investigate the influence of preoperative patient comorbidities on inpatient mortality and need for surgery.Methods: Patients admitted with pulmonary aspergillosis between 2007 to 2015 were identified in the National Inpatient Sample dataset. Inpatient mortality rates were compared between patients treated medically and surgically. Predictors of mortality, surgical intervention, and non-elective admission were evaluated using multivariable logistic regression.Results: Among a population estimate of 112,998 patients with pulmonary aspergillosis, 107,606 (95.2%) underwent medical management alone and 5,392 (4.8%) underwent surgical resection. Positive predictors for surgery included hemoptysis, and history of lung cancer or chronic pulmonary diseases. Surgically treated patients had a lower inpatient mortality when compared to those treated medically (11.5% vs. 15.1%, P<0.001) in univariate analysis, but this finding did not persist in multivariable analysis (AOR 0.97, P=0.509). The odds of mortality were lower in patients undergoing video assisted thoracoscopic surgery compared to an open approach (AOR 0.77, P=0.001). Among patients treated surgically, mortality was higher in those with a history of lung cancer, solid organ transplantation, liver disease, human immunodeficiency virus infection, hematologic diseases, chronic pulmonary diseases, and those admitted non-electively requiring surgery.Conclusions: In this generalizable study, medical and surgical management of pulmonary aspergillosis were comparable in terms of inpatient mortality. However, non-elective admission and patients with select comorbidities have significantly worse outcomes after surgical intervention.

Chronic Necrotizing Pulmonary Aspergillosis After SARS-CoV-2 Infection – A Case Report

“…Patients with pulmonary aspergillosis treated with surgery had a lower inpatient mortality compared to medical treatment; mortality rate was lower in video assisted thoracoscopic surgery, compared to open surgery [12]. In our case open surgery was recommended because the preoperative diagnosis was unclear.…”

Long-term survival following medical management of Aspergillus endocarditis with dissemination as a consequence of steroid therapy in severe COVID-19 pneumonia

“…Prognosis in patients with Aspergillus endocarditis is poor, with an estimated 96% mortality rate in patients treated with medical therapy alone [ 9 ]. Surgically treated patients had a lower inpatient mortality when compared to those treated medically [ 10 ]. Early diagnosis is crucial for appropriate antimicrobial therapy and surgical consideration.…”

Two case reports of preoperative selective artery embolization with robotic-assisted thoracoscopic lobectomy for chronic cavitary pulmonary aspergillosis: technology, safety and short-term outcomes

“…In a previous study, Chen et al reviewed 310 patients who underwent thoracotomy and 76 patients who underwent attempted VATS lobectomy for SPA and CPA, and concluded that the patients who underwent VATS had shorter hospital stays and fewer complications than those who underwent thoracotomy (7). VATS is an alternative to thoracotomy, especially for SPA and CPA without infiltration to the hilum (8)(9)(10)(11).…”