The Influence of Reconstructive Technique on Perioperative Pulmonary and Infectious Outcomes Following Chest Wall Resection

Abstract

Emerging technologies for prosthetic reconstruction after chest wall resection have yielded a wide variety of reconstructive options for thoracic surgeons. The ideal chest wall reconstruction and its impact on perioperative outcomes has not been well defined. Our goal was to determine whether mesh characteristics such as rigidity or absorbability altered perioperative pulmonary and infectious outcomes. Our institutional database was queried for patients who underwent chest wall resection and reconstruction for primary or secondary chest wall tumors between the years 1998 and 2013. A focused chart review supplied clinical and perioperative variables. The main study outcomes focused on perioperative pulmonary and wound/implant infectious complications. Univariate and multivariate analyses were performed to identify variables associated with outcome. We identified 1,096 patients who underwent chest wall resection during the study period, of which 427 required chest wall reconstruction. Pulmonary complications occurred in 24% (n= 102 of 427) of patients. We observed no significant difference in pulmonary complications between those that had a rigid versus flexible chest wall reconstruction (p= 0.401; OR, 1.43; 95% CI, 0.83-2.43). The odds of pulmonary complications increased with each additional resected rib (OR, 1.43; 95% CI, 1.2-1.71). Multivariable analysis identified the number of resected ribs (OR, 1.26; 95% CI, 1.00-1.59) and concomitant lobectomy (OR, 3.59; 95% CI, 1.62-7.92) as variables associated with perioperative pulmonary morbidity. Infectious complications occurred in 13 patients and were not predicted by the use of permanent versus absorbable prosthetic materials (p= 0.575). The type of reconstructive material, whether with rigid, flexible, permanent, or biologic characteristics, does not appear to influence perioperative pulmonary or infectious wound complications. Rather, the number of resected ribs and the concomitant lung parenchymal resection predict pulmonary morbidity following chest wall resection. Depending on the circumstances, an effective chest wall reconstruction can be achieved with either rigid or flexible prosthetic material.