Predisposing factors of atelectasis following pulmonary lobectomy

Background : The aims of our study were to investigate postoperative atelectasis complicating pulmonary lobectomy, identify risk factors and evaluate its relationship to other postoperative complications. Material and methods : From January 2004 to April 2007, 412 patients underwent pulmonary lobectomy. We performed a retrospective analysis of our prospective database. Post-lobectomy atelectasis (PLA) was defined as an ipsilateral opacification of the remaining lobe with an ipsilateral shift of the mediastinum on the chest radiography, requiring bronchoscopy. Results : The incidence of PLA was 6.6%, comprising 29% of all postoperative pulmonary complications seen. There was no statistically significant difference in patient age, gender, ASA score, cardiovascular co-morbidity or operation time for the PLA group versus the group without this complication.. Current smokers were at a higher risk for PLA, but this incidence did not reach statistical significance. Chronic obstructive pulmonary disease (COPD) was the only pre-operative variable increasing the risk of PLA (p < 0.05). Patients undergoing a right upper lobectomy, either on its own or in combination with a right middle lobe resection, had a significantly higher incidence of PLA when compared with all other types of resection (p < 0.05). Conclusions : Patients with COPD and those undergoing right upper lobe resection have an increased risk of PLA. In this group of patients we should use pre-operative (cessation of cigarette smoking, treatment of airflow obstruction in patients with COPD), intra-operative (duration of operation) and postoperative (intensive physiotherapy and effective postoperative pain control) measures to decrease the risk of PLA. Although often solitary, PLA is associated with a longer hospital stay.