Infections in 346 consecutive video-assisted thoracoscopic procedures

Background: Postoperative infections, as related to risk factors, in patients undergoing videoassisted
thoracoscopic surgery (VATS) procedures have been studied infrequently.
Materials and Methods: We evaluated 346 consecutive patients who underwent VATS procedures
between October 1996 and June 2002 at our center. Patients preoperatively were free
of chest infections and were divided into two groups: Group A (n 5 139) who underwent lung
wedge resection; group B (n 5 207), who underwent pleural biopsy (n 5 183) or biopsy of a
mediastinal mass (n 5 24). We recorded prospectively the following preoperative infection
risk parameters: Hemoglobin concentration, hematocrit, serum albumin concentration, lymphocyte
count, length of preoperative stay, duration of surgery, blood transfusion, age, comorbidity,
and chronic obstructive pulmonary disease specifically (COPD, measured as
FEV1 ,70% of expected). Short-term antibiotic prophylaxis was given to 94% of patients in
group A and to 90% of patients in group B. As outcome measures we recorded the occurrence
of postoperative infections within 30 days (surgical site infection, pneumonia, empyema) and
the final patient outcome.
Results: Patients who developed postoperative infections (all the above types included)
were 17/346 (4.9%), the difference between group A (5.0%) and group B (4.8%) being not significant.
The overall surgical site infection rate was 1.7%. Groups A and B showed a similar
incidence of surgical site infection (2.8% vs. 1.0%; p 5 NS), of pneumonia (2.8% vs. 3.4%; p 5
NS), and of empyema (0.7% vs. 2.0%; p 5 NS). Among assessed infection risk parameters, a
FEV1 ,70% of expected was the only parameter associated with a significantly increased incidence
of surgical site infection (p , 0.05).
Conclusions: This prospective study confirms that the wound infection rate is low (1.7%)
after minimally invasive VATS procedures. The cumulative incidence of postoperative infections
(including wound infection, pneumonia, empyema) was similar after lung wedge resection
and after pleural or mediastinal mass biopsy procedures. Among the infection risk
parameters, COPD was the only parameter associated with a significantly increased incidence
of postoperative infection. Our results suggest that patients with COPD who undergo VATS
for lung wedge resections and for pleural/mediastinal biopsy should receive antibiotic prophylaxis
to prevent surgical site infection.