A new accelerated treatment concept developed by researchers at the University Hospital of Zurich is showing promising results for patients suffering from postpneumonectomy empyema (PPE), particularly those with accompanying bronchopleural fistula (BPF). Postpneumonectomy empyema is a serious complication faced by patients who have undergone pneumonectomy, with studies indicating up to 16% incidence rates and high mortality associated with conditions like BPF, which can complicate recovery significantly.
The study, which analyzed clinical outcome data from November 2005 to July 2020, involved 58 patients undergoing treatment for PPE, among which 19 had bronchopleural fistula. The researchers implemented their accelerated treatment concept, which incorporated repeated surgical debridement of the pleural cavity, negative pressure wound therapy, and the installation of antibiotic solutions. This method aims to effectively manage the large infected pleural cavity and improve patient outcomes.
Traditionally, management of postpneumonectomy empyema has been complex, with the presence of BPF significantly increasing mortality rates—from 25% to as high as 71%—due to possible spillage to the remaining lung and associated septic complications. This new accelerated treatment protocol is geared toward optimizing the recovery and treatment of patients during such high-risk interventions.
Key findings from the study reveal very encouraging results. Within 30 days, 15.5% of patients had died, which indicated no significant differences between the two groups considered (those with and without BPF). The 90-day mortality rate was also shown to trend lower for Group A (those with BPF) compared to Group B, showing potential advantages of the new treatment method.
Specifically, treatment led to the complete resolution of empyema across all patients. Those with BPF showed comparable recurrence rates of empyema, and hospital stays were not significantly different between groups, indicating the procedure was equally effective yet potentially less burdensome on patient resources.
"With our accelerated treatment concept, postpneumonectomy empyema with bronchopleural fistula could effectively and safely be treated," the authors noted, stressing the success of their methodological approach.
While significant, the results must be placed within the larger framework of underlying health conditions. Patients with malignancies often had postoperative complications, but no direct relationships to the innovative treatment method were noted, underscoring the efficacy of this treatment across both patient groups.
Overall, researchers concluded, "Presence of BPF had no significant impact on short term survival and was not a risk factor as described in other reports," challenging the prevailing assumptions surrounding these risk factors.
With compelling results now provided through this study, it legitimizes the Zurich team's accelerated treatment concept as both feasible and efficient for managing PPE, opening new avenues for future research and applications. By reducing the need for more invasive procedures such as the Clagett intervention, the Zurich approach could fundamentally shift practices concerning postpneumonectomy recovery processes.
Future studies should seek to confirm these preliminary findings and explore the potential of this protocol to be adapted across different surgical contexts, particularly for patients with complex health profiles. The results present strong evidence for advocating the accelerated treatment concept as the standard care procedure for patients experiencing postpneumonectomy empyema.