SATS 2009 Final Program - Scandinavian Association for Thoracic ...

P01:12
REOPERATION FOR BLEEDING FOLLOWING OPEN HEART SURGERY IN ICELAND
Smarason Njall 1 , Sigurjonsson Hannes 1 , Hreinsson Hreinsson 1 , Arnorsson Þorarinn 1 , Gudbjartsson Tomas 1
1) Landspitali University Hospital, Iceland
Introduction
Postoperative bleeding is a potentially fatal complication following open heart surgery, with studies reporting a
reoperation-rate for bleeding in the range of 2-6%. In Iceland surgical outcome after such reoperations has not been
studied before.
Material and methods
This retrospective study included all adults that underwent open heart surgery in Iceland between 2000-2005, and
were reoperated for bleeding.
Results
There were 103 reoperations (mean age 68 yrs, 76% males), out of 1295 open heart procedures performed during
the same period, giving a reoperation-rate of 8%. One third of the patients were taking aspirin and 8% clopidogrel
less than 5 days before surgery. The bleeding in the primary operation averaged 1523 ml (range 300-4780) and
3942 ml for the first 24 hours postoperatively. Every other patient was reoperated on within 2 h and 97% within
24 hours. The patients received 16.5 units of packed cells, 15.6 units of plasma and 2.3 sets of thrombocytes. The
most common postop complication was atrial fibrillation (58.3%), pleural effusion that needed drainage (24.3%),
myocardial infarction (23.3%) and sternal wound infection (11.7%). Median length of stay was 14 days (range 6-85),
including 2 days (range 1-38) in the ICU. Operative mortality was 15.5% and 1-year crude survival 79.6%.
Conclusion
Reoperation-rate of 8% is in the higher range compared to other studies. Bleeding is a serious complication, with
high morbidity and significant mortality. Furthermore, cost is increased due to expensive transfusions and extended
hospital stay. This emphasizes the necessity to find means to reduce post-operative bleeding.
P01:13
SURGICAL TREATMENT OF NEUROENDOCRINE BRONCHIAL TUMORS AT KAROLINSKA UNIVERSITY HOSPITAL
Brodin Daniel 1 , Bergman Per 1 ,
1) Karolinska University Hospital, Sweden
Objective
Due to the excellent prognosis of typical carcinoids (TC), parenchymal saving has been addressed for discussion
as an alternative to anatomical resections. But many authors mean that there is not sufficient data to recommend
parenchymal-saving (limited) operations in any carcinoids. The aim of the present study was to determine factors
that could influence the long-time survival of patients treated surgically for neuroendocrine bronchial tumors and
thereby help to establish criteria of limited operation.
Methods
The study was based on retrospective analysis of a total of 45 patients who were surgically treated for neuroendocrine
bronchial tumours between 1987-2004. Cumulative survival was estimated by the Kaplan Meier method. Differences
in survival were tested using log rank test.
Results
The 45 patients constituted 9 % of all operated and diagnosed lung tumours. Twenty-four were classified with TC,
five with atypical carcinoids (AC), nine with small cell lung cancer (SCLC) and three with large cell lung cancer
(LCNE). Four patients with carcinoids could not be further sub-classified. Overall 5-year survival rate was 73 %, for
TC 96 %, AC 60 %, SCLC 22 % and LCNE 33%. Smokers and men had a shorter survival compared to non-smokers
and women. Patients with AC had a higher mean age (67.9) than patients with TC (57.6).
Conclusion
There is a favourable outcome for the TC and these patients could be considered for parenchymal-saving
operations.
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