Bronchopleural fistula: A multi-institutional analysis of the treatment outcomes and prognostic factors in the ESSG-01 study

Abstract OBJECTIVES Bronchopleural fistula (BPF) is a postoperative complication with a poor prognosis, and its treatment remains challenging. This study aimed to accumulate cases through a multi-institutional registry and gain insights to improve the treatment outcomes. METHODS This retrospective multi-institutional study included patients who developed BPF after undergoing thoracic surgery between January 2000 and July 2023. The primary end-point was the BPF cure rate. Secondary end-points included overall survival and factors associated with non-cure. RESULTS This study included 81 patients. Endoscopic interventions were performed in 29.6% of patients, and BPF cure with endoscopic treatment alone was achieved in 20.8% of them. Surgery for BPF was performed in 85.2% of the patients, with open-window thoracostomy being the most frequent procedure. Among open-window thoracotomies, the cure rates with muscle flaps and omentum for closing windows were 82.4% and 100%, respectively. Overall, BPF was cured in 53.1% of the patients, while 46.9% were not cured. The mortality rate during the observation period was 58.0%, with BPF-related deaths accounting for 48.9%. A multivariate analysis identified low albumin levels (<3.0 g/L) and low hemoglobin levels (<11.0 g/L) at BPF onset as significant non-cure factors (odds ratio: 4.12, 95% CI: 1.43–11.80; odds ratio: 3.53, 95% CI: 1.28–9.75, respectively). CONCLUSIONS BPF remains a postoperative complication with both high non-cure and mortality rates. The nutritional status, particularly the albumin and hemoglobin levels at onset, significantly influences the outcomes, thus highlighting the importance of enhanced perioperative nutritional management to improve the BPF outcomes.