Complete Lobar Collapse Following Pulmonary Lobectomy

Study objective To define the most severe form of postlobectomy atelectasis and determine its incidence, predisposing factors, and clinical ramifications. Design Retrospective case control. Setting The thoracic surgery unit at a 900-bed tertiary care hospital. Patients or participants Two hundred eighteen patients undergoing pulmonary lobectomy or bilobectomy over a 7-year time period. Measurements and results Severe postlobectomy atelectasis (SPLA) was defined as complete ipsilateral lobar or bilobar collapse with whiteout of the involved lobe(s) and mediastinal shift on the chest radiograph. Data were collected consisting of patient age, lobe(s) resected, type of postoperative pain control, length of hospital and ICU stay, preoperative pulmonary function, and single- vs double-lumen tube intubation during surgery. The incidence of SPLA was 7.8%, comprising 24.6% of all postoperative complications seen. There was no statistically significant difference in patient age, preoperative room air Po 2 , and preoperative FEX 1 /FVC ratio for the SPLA group vs the group without this complication. Patients with SPLA had significantly longer ICU stays (112.7 h vs 28.4 h; p Conclusions We conclude that SPLA as defined in this study is an important postoperative complication with a significant incidence. Although patients undergoing right upper lobectomy are markedly predisposed to this problem, the exact pathophysiology remains unclear. Factors shown to be causes of less severe forms of postoperative atelectasis do not seem to contribute to the formation of SPLA, indicating that these two complications may be two unrelated entities.