Thoracic surgery in a tertiary care institute-Our experience of 4 years

Background: Thoracic Surgery is undertaken for a variety of acquired or congenital intrathoracic lesions. In India majority of elective thoracic surgical procedures include decortication for empyema, lung resection surgery for benign lung diseases like bronchiectasis, Aspergilloma and benign lung tumors and resection of mediastinal tumors. In India operable bronchogenic carcinomas are very few due to delayed diagnosis. In the last few years due to early diagnosis and treatment, incidence of major complications of intra thoracic infection and empyema have decreased in India. Objectives of our study were to find out the most commonly performed thoracic surgical procedures and major post operative complications including immediate post-operative mortality in a tertiary care institute. Methodology: This was a retrospective record based study. All elective thoracic surgeries conducted by the thoracic surgery department at A.J. Institute of Medical Sciences & Research Centre, Mangaluru from August 2011 to July 2015 were included in the study. Cardiovascular surgeries, bowel and esophageal surgeries and all emergency thoracic procedures secondary to trauma were excluded from the study. Results: Data analysis was done based on frequency distribution. Total cases were 70 which included 52 males and 18 Females. Male to Female ratio was 3:1. Most common surgical procedure was decortication for empyema, 17 cases (24.2%). Majority of the decortications, 12 cases (70.5%) were right sided. Second most common procedure was Lobectomy, 14 cases (20%). The most common lobe resected was left upper lobe, 7 cases (42.8%). Mediastinal mass lesion excision surgeries were13 (18.6%). There were 6(8.5%) pneumonectomies, all of which were left sided. All pneumonectomies were done for post-tubercular destroyed lung. Average post-operative stay in intensive care unit was 2 days. Average post operative hospital stay was 9 days. Immediate post-operative complications occurred in 9 in cases, 4(44.4%), all were due to pulmonary cause. All these patients had hypoxia. Two patients required mechanical ventilation for 3 days. No post-operative mortality was recorded. Conclusions: In our institution, most common thoracic surgical procedure was decortication. Majority of patients were males. Average hospital stay was 9 days with 2 days post-operative intensive care. There was no post-operative mortality. Introduction Thoracic surgery is undertaken for a variety of acquired and congenital intra-thoracic lesions [1]. Thoracic surgery is performed to treat diseases or injuries of intra thoracic organs. Thoracic structures treated by surgery include esophagus, trachea, lungs, pleura, Mediastinum, heart, blood vessels, diaphragm and chest wall. Empyema and tuberculosis were the main indications for thoracic surgery at the beginning of the 20 century [1]. Majority of thoracic surgeries are now done to treat traumatic injuries, esophageal diseases and lung cancer. Lung transplantation and lung volume reduction surgery for emphysema are also being performed increasingly in the west. Like other surgical fields thoracic surgery is evolving very fast. Newer modalities like video assisted thoracic surgery and robotic surgery is now being performed in many centers. Most common elective thoracic surgery is done for treatment of empyema [1]. With the advent of antibiotic and better treatment facilities, incidence of empyema is decreasing. Moreover in many centers early empyema is now being treated by video assisted thoracoscopy. Hence open thoracotomy for empyema is now less commonly being performed in the west [1]. Article Info Received: 5th July, 2019 Accepted: 5th August, 2019 Published Online: 18th September, 2019