Reassessing delayed chest closure in lung transplantation: Outcomes from a propensity score-matched cohort.

OBJECTIVE: Delayed chest closure (DCC) is a strategy for managing complex lung transplantation cases. We compared the influences as well as short- and long-term outcomes of DCC to those of primary chest closure (PCC). METHODS: We retrospectively analyzed lung transplantation procedures between September 15, 2014, and February 25, 2024, at a single center, excluding single-lung, redo, and multiorgan cases. Propensity score matching balanced donor, recipient, and intraoperative factors. Outcomes and survival were evaluated using univariable/multivariable and Kaplan-Meier analyses, respectively. RESULTS: Of 692 patients, 127 (18%) underwent DCC and 565 (82%) underwent PCC; 86 well-matched pairs were generated. Factors independently associated with DCC included increasing mean pulmonary artery pressure at registration (adjusted odds ratio [aOR], 1.028; 95% CI, 1.002-1.056; P = .038), extracorporeal membrane oxygenation bridge to transplant (aOR, 2.796; 95% CI, 1.138-6.869; P = .025), donation after circulatory death allograft (aOR, 3.263; 95% CI, 1.620-6.571; P < .001), cardiopulmonary bypass during transplant (aOR, 2.613; 95% CI, 1.454-4.696; P = .001), greater transfusion volume (aOR, 1.354 per unit of packed red blood cells; 95% CI, 1.233-1.487; P < .001), and prolonged ischemic time (aOR, 1.192 per hour; 95% CI, 1.063-1.336; P = .003). Postoperatively, DCC recipients experienced higher rates of grade 3 primary graft dysfunction at 72 hours (49% vs 23%; P = .008), mechanical ventilation at 72 hours, extracorporeal membrane oxygenation use, tracheostomy, prolonged ventilatory support, dialysis, and longer hospitalizations (all P values < .05). Rates of sternal disunion, empyema, and unplanned return to operating room (all P values > .3) and overall survival (P = .505) were comparable between groups. CONCLUSIONS: Well-matched patients who underwent DCC or PCC had comparable rates of pleural space infection, sternal nonunion, and overall survival, although DCC patients had higher rates of early postoperative morbidity.