Incidence, aetiology and outcomes of major postoperative haemorrhage after pulmonary lobectomy

Abstract

OBJECTIVES Post-lobectomy bleeding is uncommon and rarely studied. In this study, we aimed to determine the incidence of post-lobectomy haemorrhage and compare the outcomes of reoperation and non-operative management. METHODS We conducted a single-institution review of lobectomy cases from 2009 to 2018. The patients were divided into two groups based on the treatment for postoperative bleeding: reoperation or transfusion of packed red blood cells with observation. Transfusion correcting intraoperative blood loss was excluded. One or more criteria defined postoperative bleeding: (i) drop in haematocrit ≥10 or (ii) frank, sustained chest tube bleeding with or without associated hypotension. Covariates included demographics, comorbidities and operative characteristics. Outcomes were operative mortality, complications, length of hospital stay and readmission within 30 days. RESULTS Following 1960 lobectomies (92% malignant disease, 8% non-malignant), haemorrhage occurred in 42 cases (2.1%), leading to reoperation in 27 (1.4%), and non-operative management in 15 (0.8%). The median time to reoperation was 17 h. No source of bleeding was identified in 44% of re-explorations. Patients with postoperative haemorrhage were more often male (64.3% vs 41.2%; P < 0.01) and more likely to have preoperative anaemia (45.2% vs 26.5%; P = 0.01), prior median sternotomy (14.3% vs 6.0%; P = 0.04), an infectious indication (7.1% vs 1.8%; P = 0.01) and operative adhesiolysis (45.2% vs 25.8%; P = 0.01). Compared with non-operative management, reoperation was associated with fewer units of packed red blood cells transfusion (0.4 vs 1.9; P < 0.001), while complication rates were similar and 30-day mortality was absent in either group. CONCLUSIONS Haemorrhage after lobectomy is associated with multiple risk factors. Reoperation may avoid transfusion. A prospective study should optimize timing and selection of operative and non-operative management.

Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor

“…The incidence of unplanned reoperation is 0.53% in our study, which is higher than the published 0.27% (after lung cancer surgeries) [ 8 ], probably due to the included benign tumors herein. Indeed, the benign tumors were reported to be more risky to postoperative bleedings than the malignant tumor, potentially due to inflammation [ 11 ]. Among the initial surgeries caused reoperations, lobectomy plus segmentectomy is the most risky probably due to more complicated manipulations and more bronchus stumps.…”

Delayed postoperative bleeding following lobectomy caused by the sharp tip of a suture: a case report

“…Postoperative bleeding after lung resection is a rare complication, but in cases where it occurs, the chest wall is the most commonly reported bleeding site [1,2]. Typically, bleeding stems from injury to intercostal arteries and can be caused by surgical staples [2].…”

“…Postoperative bleeding is a rare, but serious complication. Previous studies have reported that bleeding occurred after pulmonary lobectomy in 2.1% of cases, and surgical materials, such as staples, can be the cause [1,2]. However, a postoperative hemorrhage caused by sutures is rare.…”

Intensive Care Unit Management after Pulmonary Lobectomy

“…Post lobectomy haemorrhage is rare but most common indication for reoperation. In a recent single centre retrospective review [44], out of 1960 lobectomies, haemorrhage occurred in 2.1% cases, leading to reoperation in 1.4% and non-operative management in 0.8% cases. The median time for reoperation was 17 hours.…”