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Complications after lung resection
After lung resection the commonest complication is prolonged air leak, the commonest rhythm problem is atrial fibrillation on day 2–3, and the most dangerous is a bronchopleural fistula after pneumonectomy — revealed by cough with fluid and a falling fluid level in the pneumonectomy space, and requiring the patient to lie on the operated side.
Why it matters in the exam
The exam presents a patient on a given day after surgery and expects the complication to be recognised by timing and finding. Prolonged air leak is defined as a leak lasting more than 5 days; it is managed with the drain, a switch from suction to water seal, a one-way valve for discharge home, and in resistant cases an autologous blood patch or pleurodesis. Atrial fibrillation occurs in about 10–20% of patients, mainly after pneumonectomy and in older patients; treatment is rate control and electrolyte correction, and anticoagulation is considered if it lasts more than 48 hours. A bronchopleural fistula usually appears in the second week after pneumonectomy, and is more common on the right, after radiotherapy or neoadjuvant therapy, and with a long stump or residual tumour.
In a bronchopleural fistula the patient coughs up serous fluid, with fever, and the X-ray shows a falling fluid level or a new air-fluid level. The first step is to lay the patient on the operated side so the fluid does not flood the healthy lung, and to drain the space; then bronchoscopy, and stump repair covered with muscle or omentum, sometimes an open chest window (Clagett or Eloesser). Other complications: post-pneumonectomy pulmonary oedema (rare but lethal, prevented by restrictive fluid administration), lobar torsion (mainly the middle lobe after right upper lobectomy — an opaque lobe on X-ray and a closed "fish-mouth" bronchus on bronchoscopy, requiring immediate surgery), hoarseness from left recurrent laryngeal nerve injury during dissection of stations 5 and 6, and chylothorax.
A late complication is post-pneumonectomy syndrome: extreme mediastinal shift, mainly after right pneumonectomy, compressing the left main bronchus and causing dyspnoea months to years after surgery.
Key points
- Prolonged air leak — more than 5 days.
- Atrial fibrillation — day 2–3.
- Bronchopleural fistula — week 2, falling fluid level.
- Lying on the operated side protects the healthy lung.
- Restrictive fluids after pneumonectomy.
Summary table
| Complication | Timing and finding | Treatment |
|---|---|---|
| Prolonged air leak | More than 5 days, bubbling in the water seal | Drain, one-way valve, blood patch or pleurodesis |
| Atrial fibrillation | Day 2–3 | Rate control, electrolytes, anticoagulation if more than 48 hours |
| Bronchopleural fistula | Week 2 after pneumonectomy, falling fluid level | Lie on the operated side, drain, stump repair with flap cover |
| Lobar torsion | Early opaque lobe, closed bronchus | Immediate surgery |
| Post-pneumonectomy pulmonary oedema | First days, ARDS | Supportive ventilation; prevention by restrictive fluids |
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Sources
- STS/AATS General Thoracic Surgery Database definitions, 2023 — Postoperative events
- AATS expert consensus guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures, 2014 — Recommendations
- Shields' General Thoracic Surgery, 8th edition (2019) — Complications of pulmonary resection
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.