Consequences of Delayed Chest Closure During Lung Transplantation

ABSTRACT Background Delayed chest closure is commonly used for cardiac surgery, however insufficient data exist to guide its management in immunosuppressed lung transplantation patients, with unclear long-term consequences. Methods We performed 769 lung transplantations between January 2009 and January 2016. Of these, 47 (6%) required delayed chest closure due to coagulopathy, respiratory intolerance and hemodynamic instability. On multivariable analysis, risk factors for delayed chest closure included double lung transplantation and longer ischemic times. To account for differences between the two groups, we performed propensity matching, generating 46 well-matched pairs. Results Among matched patients with appropriate antimicrobial prophylaxis, we found no difference in 30-day prevalence of pneumonia, empyema, Clostridium difficile, blood stream and deep wound infections. There was also no difference in 6-month composite infection rates. However, delayed chest closure patients received more transfusions within 5 days of transplantation (median 7 vs. 3 units, p 5 days (80% vs. 41% p Conclusions Use of delayed chest closure does not yield higher infections or worse long-term survival, however it may be associated with increased in hospital morbidities and worse long-term pulmonary function.