Do pleural adhesions influence the outcome of patients undergoing major lung resection?

OBJECTIVES: Our goal was to investigate whether pleural adhesions identified during an operation can induce adverse events. We investigated the outcome of major lung resection in patients with pleural adhesions encountered on entry into the pleural cavity. METHODS: We conducted a retrospective analysis of 144 patients undergoing major lung resection over a period of 9 months. Recorded data included demographics, comorbidities, surgical data, fluid volume drainage (on postoperative days [ POD] 1 and 2 and in total), the overall and pleural space-associated morbidity (empyema, prolonged air leak or drainage, space issues), 30-day and late mortality rates. Patients were grouped according to the presence or not of adhesions observed when we entered the chest. RESULTS: Differences between patients without versus patients with adhesions were recorded for operative time (138 vs 169.3 min, P < 0.02), postoperative drainage on POD1 and POD2 (328.6 vs 478.5 ml, P < 0.01 and 214 vs 378 ml, P < 0.01 respectively), duration of air leak (1 vs 2 days, P = 0.03), duration of chest tube stay (2 vs 4 days, P < 0.01) and pleural morbidity (21.1% vs 38.8%, P = 0.02). There were no differences recorded in the 2 groups on conversion rates (2.5% vs 14.3%, P = 0.46), 30-day (1.1% vs 4.1%, P = .73) and late deaths (log-rank, P = 0.70). Pleural morbidity differed if the chest tube was removed on or earlier than POD2 (57.9% vs 36.9%, P = 0.02). We also calculated differences between those patients with adhesions involving the lower chest (55.1%) versus the rest of the group and specifically drainage on POD1 and POD2 (540.9 vs 372.1 ml, P < 0.01 and 392.5 vs 261 ml, P = 0.02, respectively) and pleural morbidity (46.4% vs 28.6%, P < 0.01). Logistic regression identified that firm, extensive adhesions, present in the lower third of the pleural cavity, are important predictors of pleural morbidity. CONCLUSIONS: Patients undergoing major lung resection who have pleural adhesions have an increased incidence of adverse surgical outcomes and higher pleural morbidity.