Surgery for Life-Threatening Massive Hemoptysis; Does the Time of Performed Surgery and the Timing of Surgery Affect the Rates of Complication and Mortality?

Abstract

The changing of clinical and surgical presentation over the course of years and the effect of the timing of surgery for the massive hemoptysis were investigated. Between 2000 and 2015, 67 patients with life-threatening massive hemoptysis who underwent surgical treatment were analyzed. The timing of surgery was defined as urgent (n=6) and planned-delayed (n=61). The time of performed surgery was divided into two parts: the previous period (2003 to 2010) (n=48) and the recent period (2010 to 2017) (n=19). There were 25 patients (37.3%) with no preoperative diagnoses. The most common postoperative diagnosis was tuberculosis (n=20, 29.8%). The rate of operation for massive hemoptysis in patients who were admitted to the hospital for hemoptysis was lower in the recent period than the previous period (2.7% versus 7.9%, p<0.001). The urgent surgery group had a higher overall complication rate than the planned-delayed surgery group (66.7% versus 38.3%). Complication in patients with tuberculosis was not different than the remaining patients (p=0.254). Major complication rate was a trend downward in the recent period (22.7 to 10.5%). Mortality increased in the presence of urgent surgery (p=0.003) and in patients who were transferred to the intensive care unit (ICU) with intubation after surgery (p<0.001). There was a tendency to significant difference between two periods in regards of mortality rate (16.7% in the previous period, 0% in the recent period, p=0.09). Our results support a trend toward improved surgical outcomes in massive hemoptysis. High mortality indicators are the presence of urgent surgery and returning to the ICU with postoperative intubation.