Bronchopleural fistula is an abnormal communication between the bronchial tree and the pleural cavity. Management strategies may vary significantly among physicians within the same institution, largely due to differences in clinical judgement and the absence of standardised treatment guidelines. We retrospectively reviewed the medical records of patients diagnosed with BPF at the Affiliated Hospital of Qingdao University between 2016 and 2023. Data on etiology, nutritional status, surgical site, treatment approach, drainage duration, and patient outcomes were analyzed. During the study period, 7,550 patients underwent lobectomy, of whom 43 (0.57%) developed postoperative BPF. Among the 24 patients managed conservatively, the 90-day mortality rate was 29.2%. In contrast, the 19 patients who received active interventions had a significantly lower 90-day mortality of 10.2%. Selection of an appropriate treatment strategy is critical in the management of BPF. In patients with identifiable risk factors, intraoperative reinforcement of the bronchial stump with fat tissue may be considered. Overall, management strategies should be individualized according to patient characteristics, fistula features, and the clinical context.
Liu et al. (2026) studied this question.