Perioperative implications of thoracic decortications: a retrospective cohort study

Abstract

PurposeAn increasing number of thoracic decortications have been performed in Manitoba, from five in 2007 to 45 in 2014. The primary objective of this study was to define the epidemiology of decortications in Manitoba. The secondary objective was to compare patients who underwent decortication due to primary infectious vs non-infectious etiology with respect to their perioperative outcomes.MethodsData for this cohort study were extracted from consecutive charts of all adult patients who underwent a decortication in Manitoba from 2007-2014 inclusive.ResultsOne hundred ninety-two patients underwent a decortication. The most frequent disease processes resulting in a decortication were pneumonia (60%), trauma (13%), malignancy (8%), and procedural complications (5%). The number of decortications due to complications of pneumonia rose at the greatest rate, from three cases in 2007 to 29 cases in 2014. Performing a decortication for an infectious vs a non-infectious etiology was associated with a higher rate of the composite postoperative outcome of myocardial infarction, acute kidney injury, need of vasopressors for > 12 hr, and mechanical ventilation for > 48 hr (44.4% vs 24.2%, respectively; relative risk, 1.83; 95% confidence interval, 1.1 to 2.9; P = 0.01).ConclusionThere has been a ninefold increase in decortications over an eight-year period. Potential causes include an increase in the incidence of pneumonia, increased organism virulence, host changes, and changes in practice patterns. Patients undergoing decortication for infectious causes had an increased risk for adverse perioperative outcomes. Anesthesiologists need to be aware of the high perioperative morbidity of these patients and the potential need for postoperative admission to an intensive care unit.

Role of Anti-Tuberculous Treatment in the Outcome of Decortication for Chronic Tuberculous Empyema

“…Complications of decortication comprise prolonged air leak (PAL), residual collection, residual pneumothorax, and mechanical ventilation; consistent with our study as well [20].…”

“…Another cohort study elaborated that an infectious etiology leading to decortication was associated with a higher risk of mechanical ventilation of around 18% due to diseased lung parenchyma [ 20 ]. It may also be attributed to the release of loculated infection, host inflammatory response, and physiological stress of anesthesia and decortication in an already vulnerable population [ 20 ]. In our study, Group A candidates required mechanical ventilation in 28.5% of cases whereas Group B required it in only 8.5% of patients (p=0.03).…”

“…Complete lung re-expansion and pleural apposition is the ultimate goal of decortication [ 20 ]. It was achieved in 60% of participants of Group B (n=21, p=0.002) compared to 22.8% (n=8) in Group A in our study.…”

Effect of post-operative physiotherapy intervention following decortication and bullectomy: a case report

“…Atelectasis of the lung is a common complication following decortications surgery. 3,7,8 Chest physiotherapy plays a vital role in improving the lung expansion and regaining the lung and chest wall mobility following decortication surgery. Various chest physiotherapy techniques have been proven to be effective in improving the lung function following thoracic surgeries.…”

“…It includes the removal of thickened and fibrotic pleura that restricts lung expansion. 2,3 Bullectomy is performed whenever there is an air-filled bulla detected on the chest radiograph. Most patients considered for surgery have symptoms of dyspnoea, pain, or spontaneous pneumothorax.…”