Postoperative intrapleural hemorrhage following pulmonary resection: a multiple-center retrospective study

Objective. To assess the incidence of postoperative hemothorax and influence of redo surgery timing on outcomes. Material and methods. A multiple-center retrospective study included 70 out of 7.796 postoperative patients who underwent redo surgery for postoperative hemothorax following lung resection between 2019 and 2024 in four specialized thoracic centers in Russia. Of these, 57 (81.4%) patients underwent anatomical resections (including 45 lobectomies), and 13 (18.6%) underwent non-anatomical wedge resections. Patients were stratified into early (<24 hours) and delayed (≥24 hours) redo surgery groups. Postoperative complications were assessed using the Thoracic Morbidity and Mortality (TMM) classification. The primary outcome was 90-day mortality. Results. The incidence of hemothorax was 1.1% after anatomical resections and 0.5% after non-anatomical resections. Ninety-day mortality was significantly lower in the early redo surgery group (12.5% vs. 36.6%, p=0.037). Early redo surgery was associated with higher rate of intraoperative identification of bleeding source (67.5% vs. 36.7%, p=0.030). The Charlson comorbidity index was significantly higher in the delayed group (p<0.001). Delayed interventions demonstrated a trend towards more severe complications and higher rates of pleural empyema. Delayed redo surgery beyond 24 hours was associated with more than threefold increase in the risk of death (OR 3.98; 95% CI 1.21–13.07). Conclusion. Early surgical intervention for postoperative hemothorax, especially within the first 24 hours, is associated with better clinical outcomes and significantly lower 90-day mortality.