A bronchopleural fistula may develop after a pneumonectomy if certain risk factors are present. Early recognition of a bronchopleural fistula is necessary to avoid serious morbidity and mortality.
Risk factors for a bronchopleural fistula:
(1) right pneumonectomy
(2) preoperative respiratory infection
(3) technical factors in how the bronchus is closed (manual closure, etc)
(4) failure to reinforce the margin with a pedicled tissue flap
(5) extensive dissection around the bronchus that interferes with arterial blood supply to the bronchial stump
(6) need for post-operative mechanical ventilation
(7) lung cancer with N2 or N3 lymph node metastases
(8) excessive radiation to the stump
(9) tumor recurrence at the stump
(10) infection within the bronchial stump
(11) diabetes mellitus
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