Perioperative bronchoalveolar lavage in thoracic surgery decreases length of stay in hospital

Irish Thoracic Society, Annual Scientific Meeting, 3-4 December 2020

Dr Ghaith Qsous from St Vincent’s University Hospital, Dublin, presented his findings on perioperative bronchoalveolar lavage in thoracic surgery. He began by explaining that chest infection after thoracic surgeries is considered one of the most common complications, accounting for 15-to-20
per cent.

As a result, post-operative infection can increase the morbidity and mortality rate of surgery to 19-to-40 per cent, and often leads to an increase in the length of hospital stay.

Bronchoalveolar lavage is a technique used to diagnose infection of the lower respiratory system. A bronchoscope is passed through the mouth or nose into an appropriate airway in the lungs, a measured amount of fluid is released and then collected for examination.

Dr Qsous carried out a retrospective study of 194 patients undergoing different thoracic surgeries from June 2013 to March 2020 in St Vincent’s University Hospital. Patients were divided into two groups: 94 controls who did not undergo perioperative bronchoalveolar lavage and 100 patients who underwent perioperative bronchoalveolar lavage.

Perioperative bronchoalveolar lavage was performed based on surgeon preferences. The overall aim of this study was to evaluate the effect of bronchoalveolar lavage on postoperative chest infection and the length of hospital stay.

Studies carried out by other research groups had already demonstrated that 88 percent of patients with a positive intra-operative bronchial culture developed a lung infection during the recovery period. They demonstrated that the positive culture is an independent risk factor for the development of lung infection postoperatively.

Another group demonstrated that bronchoalveolar lavage on head-injury patients requiring tracheostomy decreased the risk of pneumonia in these patients from 35 per cent to 14 per cent, and the days of hospital stay were significantly reduced by bronchoalveolar lavage. These studies provided the rationale for Dr Qsous’s research question.

Post-surgery, it was found that the bronchoalveolar lavage group of this study had an 11 per cent incidence of postoperative lung infection, which was significantly lower when compared to the control group which had a 22 per cent incidence of postoperative lung infection. Infection was diagnosed based on clinical features, blood tests, imaging, and culture results of bronchoalveolar lavage samples.

All patients received one dose of antibiotics (second generation cephalosporin) perioperatively, based on hospital guidelines. Furthermore, the bronchoalveolar lavage group had an average hospital stay of 5.6 days, while the control group had an average stay of 9.4 days. Both of these findings were statistically significant.

The perioperative bronchoalveolar lavage was also of diagnostic value for the patients who underwent this procedure, but still obtained a chest infection after surgery. Of the 11 per cent of patients who underwent bronchoalveolar lavage but still obtained a chest infection, the bronchoalveolar lavage showed that 73 per cent of these individuals had positive culture, and 64 per cent had pus cells. These findings were used to help treat the patient’s chest infections.

Dr Qsous concluded his presentation by restating his findings that perioperative bronchoalveolar lavage decreases the risk of postoperative chest infection and length of hospital stay, and reminding the audience that it can also be used as a diagnostic method to treat patients with a chest infection.