Bronchial Suturing Techniques After Lung Transplant: A Single Surgeon Analysis

Abstract

<h3>Purpose</h3> In lung transplantation (LTx) postoperative airway complications can increase morbidity and mortality. Current literature offers little analysis examining a single surgeon's work. We assessed postoperative bronchial complication rates, treatments, and survival outcomes in LTx performed by a single surgeon and stratified data by suturing technique. <h3>Methods</h3> A single surgeon's LTx (n=444) were analyzed from 901 total LTx done between Feb 2012- March 2021. Continuous suturing (CS) and intermittent suturing (IS) techniques were compared. CS technique was done with 3/0 polypropylene suture on an SH needle. IS is used on the membranous portion of the anastomosis and multiple interrupted 3/0 polypropylene sutures are used for the cartilaginous portion. Demographic and clinical data, post op bronchial complications, and their interventions were compared and categorized. Survival was compared with Kaplan-Meier curves and log-rank tests. Cox regression analysis was run using all variables to assess impact on survival. P values <0.05 were considered significant. <h3>Results</h3> Of 444 patients in this single surgeon study, 259 received IS and 185 received CS. ECMO was utilized in 19 CS patients vs 18 IS patients IS (p = 0.371). There was no significant difference in post-transplant complication rates (p = 0.629). The most common complications were stenosis (CS14; IS-19), ischemia (CS 0; IS-7), and stenosis + malacia + dehiscence (CS 4; IS9). Treatment for bronchial complications was 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 with all variables showed that the type of induction (Hz 1.48; p=0.01) and CPB (Hz 1.44; p=0.024) had a significant effect on survival. <h3>Conclusion</h3> Analysis of suturing techniques in a single surgeon at a single center showed comparable survival outcomes, bronchial complication rates, and follow up treatments between IS and CS techniques.