K. Montgomery1, G. Masters1, M. A. Kashem1, E. H. Ander1, Y. Toyoda1 1Temple University, Cardiovascular Surgery, Philadelpha, PA, USA
Introduction:
Post-operative airway complications following Lung transplantation (LTx) contribute to transplant mortality and morbidity. Most transplant centers analyze and report such post-op data where multi-surgeons operate in transplant centers. A single surgeon data analysis is lacking. We have assessed post-operative airway bronchial complications in our single center done by all surgeons and separately analyzed a single surgeon’s transplant surgical outcomes in suturing techniques to understand the survival outcomes, bronchial complications rates, and follow-up results.
Methods:
Out of 901 total lung transplantation that were done between Feb 2021 to Mar 2021, a single surgeons lung transplant procedures (n=444) were analyzed. Single surgeon’s continuous suturing (CS) and intermittent suturing (IS) techniques were evaluated for comparison. CS technique was performed with 3/0 polypropylene suture on an SH needle. IS used the same technique for the membranous portion of the anastomosis and multiple interrupted 3/0 polypropylene sutures for the cartilaginous portion. Demographics and clinical parameters were contrasted between two suturing groups. The groups were compared for post-operative bronchial complications which were categorized, and then required interventions afterwards were also analyzed. Survival was compared by generating Kaplan-Meier curves and log-rank tests. Cox regression analysis was run using all variables to ascertain their impact on survival. P values <0.05 were considered significant.
Results:
From the 444 patients of this single surgeon study, 259 received IS and 185 received CS. Demographic parameters between suture groups were as follows: age (p = 0.017), sex (p = 0.023), race (p =0.20), LAS (p < 0.0001), BMI (p = 0.056), and height (p = 0.982). There was ECMO utilization in 19 patients with CS vs 18 patients with IS (p = 0.371).
There was no significant difference in post-transplant complication rates (p = 0.629). The most common complications were stenosis (CS-14; IS-19), ischemia (CS 0; IS-7), and stenosis + malacia + dehiscence (CS 4; IS-9). Treatment for bronchial complications were varied including dilation and stent placement when indicated for the complications of both CS and IS. Kaplan-Meier curve showed no difference in survival outcomes between groups (p = 0.562). Cox regression analysis using all variables showed the type of induction (Hz 1.48; p=0.01) and CPB (Hz 1.44; p=0.024) had a significant effect on survival.
Conclusion:
A single surgeon’s surgical suturing techniques adaptation in a multi-center settings of lung transplantation showed both interrupted and continuous surgical suturing techniques can be performed in selected patients. Our data indicated no difference in survival outcomes when the IS vs CS technique was utilized in a large cohort of lung transplant patients. In addition, bronchial complications and their follow-up treatment interventions were found to be comparable.
