Sub-threshold hypoalbuminemia, anemia, and occult infection trigger post-lobectomy bronchopleural fistula: a case report.

A 56-year-old man presented with expectoration of blood clots (hemoptysis) and detached staples after undergoing left upper lobectomy plus wedge resection of the left lower lobe for lung cancer. Postoperative staple-line dehiscence is uncommon, occurring in approximately 1.5-3% of cases. When staples fail, the complication is frequently accompanied by bronchopleural fistula (BPF), a potentially catastrophic event that may determine empyema, aspiration pneumonia, and even erosion of major thoracic vessels with lethal hemorrhage. Morbidity and mortality from empyema are markedly higher in vulnerable populations such as the elderly, infants, and pregnant women. Current guidelines reserve prophylactic coverage of the bronchial stump for patients with clearly defined high-risk features-right pneumonectomy, neoadjuvant therapy, residual tumor at the stump, or diabetes mellitus-yet this policy may overlook individuals who harbor multiple, less overt risk factors. The possibility of BPF in patients with lower risk factors is not clearly evident in literature, and most studies focus on traditional high-risk populations. We report on a patient who possessed three such under-recognized predictors of BPF and ultimately developed complication despite standard surgical care.