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Lobdell KW, Perrault LP, Drgastin RH, Brunelli A, Cerfolio RJ, Engelman DT. Drainology: Leveraging research in chest-drain management to enhance recovery after cardiothoracic surgery. JTCVS Tech 2024; 25:226-240. [PMID: 38899104 PMCID: PMC11184673 DOI: 10.1016/j.xjtc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Kevin W. Lobdell
- Sanger Heart & Vascular Institute, Wake Forest University School of Medicine, Advocate Health, Charlotte, NC
| | - Louis P. Perrault
- Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | - Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | | | - Daniel T. Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass
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Gioutsos K, Ehrenreich L, Azenha LF, Quapp CS, Kocher GJ, Lutz JA, Peischl S, Dorn P. Randomized Controlled Trial of Thresholds for Drain Removal After Anatomic Lung Resection. Ann Thorac Surg 2024; 117:1103-1109. [PMID: 37734641 DOI: 10.1016/j.athoracsur.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The criteria for chest drain removal after lung resections remain vague and rely on personal experience instead of evidence. Because pleural fluid resorption is proportional to body weight, a weight-related approach seems reasonable. We examined the feasibility of a weight-adjusted fluid output threshold concerning postoperative respiratory complications and the occurrence of symptomatic pleural effusion after chest drain removal. Our secondary objectives were the hospital length of stay and pain levels before and after chest drain removal. METHODS This was a single-center randomized controlled trial including 337 patients planned for open or thoracoscopic anatomical lung resections. Patients were randomly assigned postoperatively into 2 groups. The chest drain was removed in the study group according to a fluid output threshold calculated by the 5 mL × body weight (in kg)/24 hours formula. In the control group, our previous traditional fluid threshold of 200 mL/24 hours was applied. RESULTS No differences were evident regarding the occurrence of pleural effusion and dyspnea at discharge and 30 days postoperatively. In the logistic regression analysis, the surgical modality was a risk factor for other complications, and age was the only variable influencing postoperative dyspnea. Time to chest drain removal was identical in both groups, and time to discharge was shorter after open surgery in the test group. CONCLUSIONS No increased postoperative complications occurred with this weight-based formula, and a trend toward earlier discharge after open surgery was observed in the test group.
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Affiliation(s)
- Konstantinos Gioutsos
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lasse Ehrenreich
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Filipe Azenha
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christopher Siegbert Quapp
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Jan Kocher
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jon Andri Lutz
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Peischl
- Interfaculty Bioinformatics Unit and SIB Swiss Institute of Bioinformatics, University of Bern, Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Song L, Chen X, Zhu L, Qian G, Xu Y, Song Z, Li J, Chen T, Huang J, Luo Q, Cheng X, Yang Y. Perioperative outcomes of bi-pigtail catheter drainage strategy versus conventional chest tube after uniportal video-assisted thoracic lung surgery. Eur J Cardiothorac Surg 2023; 64:ezad411. [PMID: 38078822 DOI: 10.1093/ejcts/ezad411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/22/2023] [Accepted: 12/09/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES Chest tube (CT) drainage is a main cause of postoperative pain in lung surgery. Here, we introduced a novel drainage strategy with bi-pigtail catheters (PCs) and conducted a randomized controlled trial to compare with conventional CT drainage after uniportal video-assisted thoracic surgery lung surgery. METHODS A single-centre, prospective, open-labelled, randomized controlled trial (ChiCTR2000035337) was conducted with a preplanned sample size of 396. The primary outcome was the numerical pain rating scale (NPRS) on the first postoperative day. Secondary outcomes included other indicators of postoperative pain, drainage volume, duration of drainage, postoperative hospital stay, incidence of postoperative complications, CT reinsertion and medical costs. RESULTS A total number of 396 patients were randomized between August 2020 and January 2021, 387 of whom were included in the final analysis. The baseline and clinical characteristics of the patients were well balanced between 2 groups. The NPRS on the first postoperative day was significantly lower in the PC group than in the CT group (2.40 ± 1.27 vs 3.02 ± 1.39, p < 0.001), as well as the second/third-day NPRS, the incidence of sudden severe pain (9/192, 4.7% vs 34/195, 17.4%, P < 0.001) and pain requiring intervention (19/192, 9.9% vs 46/195, 23.6%, P < 0.001). In addition, the medical cost in the PC group was lower (US$7809 ± 1646 vs US$8205 ± 1815, P = 0.025). Univariable and multivariable analyses revealed that the drainage strategy was the only factor influencing the incidence of pain requiring intervention. CONCLUSIONS The drainage strategy with bi-PCs in patients undergoing uniportal video-assisted thoracic surgery lung surgery alleviates postoperative pain with adequate safety and efficacy.
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Affiliation(s)
- Liwei Song
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xingshi Chen
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Zhu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Gang Qian
- Department of Thoracic Surgery, Zhangjiagang Third People's Hospital, Suzhou, China
| | - Yanhui Xu
- Department of Thoracic Surgery, Zhejiang Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Zuodong Song
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiantao Li
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tianxiang Chen
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia Huang
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qingquan Luo
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xinghua Cheng
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yunhai Yang
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Scarci M, Gkikas A, Patrini D, Minervini F, Cerfolio RJ. Editorial: Early chest drain removal following lung resection. Front Surg 2023; 10:1185334. [PMID: 37066007 PMCID: PMC10102361 DOI: 10.3389/fsurg.2023.1185334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Marco Scarci
- Department of Thoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
- Correspondence: Marco Scarci
| | - Andreas Gkikas
- Department of Thoracic Surgery, University College London Hospitals, London, United Kingdom
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals, London, United Kingdom
| | - Fabrizio Minervini
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Robert J. Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
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Yang F, Wang X, Xu H, Aramini B, Zhu Y, Jiang G, Fan J. A novel drainage strategy using chest tube plus pleural catheter in uniportal upper lobectomy: A randomized controlled trial. Thorac Cancer 2022; 14:399-406. [PMID: 36562112 PMCID: PMC9891854 DOI: 10.1111/1759-7714.14759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In this study we explored whether one pleural catheter plus single chest tube drainage could achieve a noninferior drainage effect when compared with the traditional two chest tubes in uniportal video-assisted thoracoscopic surgery (VATS) for an upper pulmonary lobectomy. METHODS Patients that underwent an upper pulmonary lobectomy from January to November 2020 were enrolled in this single-center, randomized, open-label, noninferiority trial. Prior to closure, patients were randomized to an intervention group who received an improved drainage strategy involving one pleural catheter with one chest tube (24 Fr), while traditional double chest tube drainage was applied for the control group. RESULTS A total of 390 patients entered the study, although 190 were excluded for changing nonuniportal surgical approaches or opting for nonlobectomy resections. Finally, 200 patients were randomized (100 in the intervention group and 100 in the control group). The baseline demographic and clinical characteristics were comparable between the groups. The incidence of pneumothorax in the intervention and control groups was similar on postoperative Day 1 (noninferiority, 10% vs. 13%, p = 0.658). In addition, there were no significant differences in secondary outcomes such as incidence of pneumothorax by Day 30, postoperative chest tube/pleural catheter removal time, amount of drainage on Day 1, total amount of drainage after operation, or postoperative hospitalization. A significantly lower pain score was observed in the intervention group (3.33 ± 0.68 vs. 3.68 ± 0.94, p = 0.003). CONCLUSIONS The new strategy is noninferior to double chest tube drainage after an upper pulmonary lobectomy offers superior pain control, and is recommended for an upper lobectomy by uniportal VATS.
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Affiliation(s)
- Fu Yang
- Department of Thoracic SurgeryShanghai Jiao Tong University First People's HospitalShanghaiChina
| | - Xing Wang
- Department of Thoracic SurgeryShanghai Jiao Tong University First People's HospitalShanghaiChina,Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Honglei Xu
- Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Beatrice Aramini
- Division of Thoracic SurgeryG.B. Morgagni‐L. Pierantoni Hospital, University of BolognaForliItaly
| | - Yuming Zhu
- Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Gening Jiang
- Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Jiang Fan
- Department of Thoracic SurgeryShanghai Jiao Tong University First People's HospitalShanghaiChina,Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
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Li R, Qiu J, Qu C, Ma Z, Wang K, Zhang Y, Yue W, Tian H. Comparison of perioperative outcomes with or without routine chest tube drainage after video-assisted thoracoscopic pulmonary resection: A systematic review and meta-analysis. Front Oncol 2022; 12:915020. [PMID: 36003771 PMCID: PMC9393739 DOI: 10.3389/fonc.2022.915020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIn recent years, an increasing number of thoracic surgeons have attempted to apply no routine chest tube drainage (NT) strategy after thoracoscopic lung resection. However, the safety and feasibility of not routinely placing a chest tube after lung resection remain controversial. This study aimed to investigate the effect of NT strategy after thoracoscopic pulmonary resection on perioperative outcomes.MethodsA comprehensive literature search of PubMed, Embase, and the Cochrane Library databases until 3 January 2022 was performed to identify the studies that implemented NT strategy after thoracoscopic pulmonary resection. Perioperative outcomes were extracted by 2 reviewers independently and then synthesized using a random-effects model. Risk ratio (RR) and standardized mean difference (SMD) with 95% confidence interval (CI) served as the summary statistics for meta-analysis. Subgroup analysis and sensitivity analysis were subsequently performed.ResultsA total of 12 studies with 1,381 patients were included. The meta-analysis indicated that patients in the NT group had a significantly reduced postoperative length of stay (LOS) (SMD = -0.91; 95% CI: -1.20 to -0.61; P < 0.001) and pain score on postoperative day (POD) 1 (SMD = -0.95; 95% CI: -1.54 to -0.36; P = 0.002), POD 2 (SMD = -0.37; 95% CI: -0.63 to -0.11; P = 0.005), and POD 3 (SMD = -0.39; 95% CI: -0.71 to -0.06; P = 0.02). Further subgroup analysis showed that the difference of postoperative LOS became statistically insignificant in the lobectomy or segmentectomy subgroup (SMD = -0.30; 95% CI: -0.91 to 0.32; P = 0.34). Although the risk of pneumothorax was significantly higher in the NT group (RR = 1.75; 95% CI: 1.14–2.68; P = 0.01), the reintervention rates were comparable between groups (RR = 1.04; 95% CI: 0.48–2.25; P = 0.92). No significant difference was found in pleural effusion, subcutaneous emphysema, operation time, pain score on POD 7, and wound healing satisfactory (all P > 0.05). The sensitivity analysis suggested that the results of the meta-analysis were stabilized.ConclusionsThis meta-analysis suggested that NT strategy is safe and feasible for selected patients scheduled for video-assisted thoracoscopic pulmonary resection.Systematic Review Registrationhttps://inplasy.com/inplasy-2022-4-0026, identifier INPLASY202240026.
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Anderson D, Chen SA, Godoy LA, Brown LM, Cooke DT. Comprehensive Review of Chest Tube Management: A Review. JAMA Surg 2022; 157:269-274. [PMID: 35080596 DOI: 10.1001/jamasurg.2021.7050] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Thoracostomy, or chest tube placement, is used in a variety of clinical indications and can be lifesaving in certain circumstances. There have been developments and modifications to thoracostomy tubes, or chest tubes, over time, but they continue to be a staple in the thoracic surgeon's toolbox as well as adjacent specialties in medicine. This review will provide the nonexpert clinician a comprehensive understanding of the types of chest tubes, indications for their effective use, and key management details for ideal patient outcomes. Observations This review describes the types of chest tubes, indications for use, techniques for placement, common anatomical landmarks that are encountered with placement and management, and an overview of complications that may arise with tube thoracostomy. In addition, the future direction of chest tubes is explored, as well as the management of chest tubes during the COVID-19 pandemic. Conclusions and Relevance Chest tube management is subjective, but the compilation of data can inform best practices and safe application to successfully manage the pleural space and ameliorate acquired pleural space disease.
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Affiliation(s)
- Devon Anderson
- Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento
| | - Sarah A Chen
- Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento
| | - Luis A Godoy
- Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento
| | - Lisa M Brown
- Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento
| | - David T Cooke
- Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento
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Wei S, Zhang G, Ma J, Nong L, Zhang J, Zhong W, Cui J. Randomized controlled trial of an alternative drainage strategy vs routine chest tube insertion for postoperative pain after thoracoscopic wedge resection. BMC Anesthesiol 2022; 22:27. [PMID: 35042458 PMCID: PMC8764795 DOI: 10.1186/s12871-022-01569-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 12/31/2021] [Indexed: 12/01/2022] Open
Abstract
Background Thoracoscopic surgery has greatly alleviated the postoperative pain of patients, but postsurgical acute and chronic pain still exists and needs to be addressed. Indwelling drainage tubes are one of the leading causes of postoperative pain after thoracic surgery. Therefore, the aim of this study was to explore the effects of alternative drainage on acute and chronic pain after video-assisted thoracoscopic surgery (VATS). Methods Ninety-two patients undergoing lung wedge resection were selected and randomly assigned to the conventional chest tube (CT) group and the 7-Fr central venous catheter (VC) group. Next, the numeric rating scale (NRS) and pain DETECT questionnaire were applied to evaluate the level and characteristics of postoperative pain. Results NRS scores of the VC group during hospitalization were significantly lower than those of the CT group 6 h after surgery, at postoperative day 1, at postoperative day 2, and at the moment of drainage tube removal. Moreover, the number of postoperative salvage analgesics (such as nonsteroidal anti-inflammatory drugs [(NSAIDs]) and postoperative hospitalization days were notably reduced in the VC group compared with the CT group. However, no significant difference was observed in terms of NRS pain scores between the two groups of patients during the follow-up for chronic pain at 3 months and 6 months. Conclusion In conclusion, a drainage strategy using a 7-Fr central VC can effectively relieve perioperative pain in selected patients undergoing VATS wedge resection, and this may promote the rapid recovery of such patients after surgery. Trial registration ClinicalTrials.gov, NCT03230019. Registered July 23, 2017.
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Yang Q, Lv S, Li Q, Lan L, Sun X, Feng X, Han K. Safety and feasibility study of uniportal video-assisted thoracoscopic pulmonary wedge resection without postoperative chest tube drainage: a retrospective propensity score-matched study. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2022; 37:ivad196. [PMID: 38092062 PMCID: PMC10936903 DOI: 10.1093/icvts/ivad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/24/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The aim of this study was to assess the impact of postoperative chest tube drainage (CTD) on safety and postoperative recovery by comparing patients with pulmonary nodule undergoing uniportal video-assisted thoracoscopic pulmonary wedge resection with and without postoperative CTD. METHODS We retrospectively analysed the data of patients who underwent video-assisted thoracoscopic pulmonary wedge resection for pulmonary nodule at our hospital between 2018 and 2022. In cases where a 12-Fr chest tube was used following the procedure, the tube was not usually removed until the day after surgery. Therefore, the eligible patients were categorized into the drainage tube or the no-drainage tube group according to the use of postoperative CTD. Propensity score matching at a ratio of 1:1 was performed using clinicopathologic and demographic variables. The highest postoperative pain score, postoperative complication rate, postoperative length of stay and hospitalization costs were compared between the 2 groups. RESULTS A total of 275 eligible patients, including 150 and 125 patients in the drainage tube and no-drainage tube groups, respectively, were included in the study. After propensity score matching, there were 102 patients in each group. The postoperative complication rate during hospitalization and at 1 week and 1 month after discharge were not significantly different between the 2 groups (P > 0.05 for all). The highest postoperative pain score was significantly lower in the no-drainage tube group than in the drainage tube group [2.02 (standard deviation: 0.81) days vs 2.31 (standard deviation: 0.76) days, P = 0.008]. The postoperative length of stay was significantly shorter in the no-drainage tube group than in the drainage tube group {3.00 [interquartile ranges (IQRs): 2.00-4.00] days vs 2.00 (IQRs: 1.00-3.00) days, P < 0.001}. Similarly, the total hospitalization costs were significantly lower in the no-drainage tube group than in the drainage tube group [33283.74 (IQRs: 27098.61-46718.56) yuan vs 26598.67 (IQRs: 22965.14-29933.67) yuan, P < 0.001]. CONCLUSIONS Omission of postoperative CTD was safe and feasible in patients with pulmonary nodule undergoing wedge resection. The no-postoperative-drainage policy can substantially shorten the length of hospital stay and reduce the postoperative pain and hospitalization costs without increasing the risk of postoperative complications.
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Affiliation(s)
- Qingjie Yang
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, China
| | - Shenghua Lv
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, China
| | - Qingtian Li
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, China
| | - Linhui Lan
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, China
| | - Xiaoyan Sun
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, China
| | - Xinhai Feng
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, China
| | - Kaibao Han
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, China
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Geraci TC, Chang SH, Shah SK, Kent A, Cerfolio RJ. Postoperative Air Leaks After Lung Surgery: Predictors, Intraoperative Techniques, and Postoperative Management. Thorac Surg Clin 2021; 31:161-169. [PMID: 33926669 DOI: 10.1016/j.thorsurg.2021.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Postoperative air leak is one of the most common complications after pulmonary resection and contributes to postoperative pain, complications, and increased hospital length of stay. Several risk factors, including both patient and surgical characteristics, increase the frequency of air leaks. Appropriate intraoperative tissue handling is the most important surgical technique to reduce air leaks. Digital drainage systems have improved the management of postoperative air leak via objective data, portability, and ease of use in the outpatient setting. Several treatment strategies have been used to address prolonged air leak, including pleurodesis, blood patch, placement of endobronchial valves, and reoperative surgery.
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Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA.
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA
| | - Savan K Shah
- Department of Cardiothoracic Surgery, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA
| | - Amie Kent
- Department of Cardiothoracic Surgery, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA
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Liu Z, Yang R, Sun Y. Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage. BMC Surg 2020; 20:301. [PMID: 33256711 PMCID: PMC7706205 DOI: 10.1186/s12893-020-00910-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023] Open
Abstract
Background To investigate whether tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage has better short-term outcomes than non-intubated approach with chest tube drainage. Methods Data were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Peri-operative outcomes between two groups were compared. Results After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 min in tubeless group and 52.8 min in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. Side effects were rare and mild, including cough and hemoptysis. No re-intervention or readmission occurred. The postoperative VAS score was significantly lower in tubeless group. Conclusions Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.
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Affiliation(s)
- Zhengcheng Liu
- Department of Thoracic Surgery, Nanjing Chest Hospital, Treatment and Research Center for Pulmonary Nodule in Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Rusong Yang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Treatment and Research Center for Pulmonary Nodule in Nanjing Medical University, Nanjing, 210029, Jiangsu, China. .,Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China.
| | - Yang Sun
- Department of Anaesthesia, Nanjing Chest Hospital, Nanjing, 210029, China
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12
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Wang D, Xu L, Yang F, Wang Z, Sun H, Chen X, Xie H, Li Y. The Improved Mediastinal Drainage Strategy for the Enhanced Recovery System After Esophagectomy. Ann Thorac Surg 2020; 112:473-480. [PMID: 33031778 DOI: 10.1016/j.athoracsur.2020.05.188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The improved drainage strategy was the transperitoneal placement of a single mediastinal drainage tube after esophagectomy. This study aimed to explore its effect on the incidence of postoperative complications, pain scores, and hospital stay. METHODS Data from 108 patients who underwent minimally invasive esophagectomy were retrospectively analyzed. Patients were divided into 2 groups: those in group A were treated with transthoracic placement of mediastinal drain and those in group B were treated with transperitoneal placement. The incidence of postoperative complications, pain scores, and postoperative hospital stay were compared. RESULTS The maximum pain scores in group B were significantly lower than those in group A from the first to the fourth postoperative days (PODs): POD1, 3.9 ± 0.7 vs 2.3 ± 0.7; POD2, 3.5 ± 0.8 vs 2.1 ± 0.7; POD3, 3.3 ± 0.8 vs 1.7 ± 0.8; and POD4, 3.1 ± 0.7 vs 1.7 ± 0.8 (all P < .001). Compared with group A, there were fewer postoperative analgesic drug users in group B (44.6% vs 17.9%; P = .005), fewer cases of pleural effusion (10.7% vs 0%; P = .045), and fewer cases of closed thoracic drainage due to pleural effusion or pneumothorax (14.3% vs 0%; P = .014). There were no significant differences in the incidence of anastomotic leakage, mediastinitis, major pulmonary complications, major abdominal complications, surgical site infection, and total postoperative complications, without statistical differences in postoperative hospital stay and 30-d mortality (all P > .05). CONCLUSIONS The transperitoneal placement of a single mediastinal drain can reduce postoperative pain and the incidence of pleural effusion, without increasing the incidence of other major postoperative complications and postoperative hospital stay.
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Affiliation(s)
- Dengyun Wang
- Department of Cardiothoracic Surgery, Huangshi Central Hospital, Affiliated Hospital of Hubei Ploytechnic University, Edong Healthcare Group, Huangshi, China
| | - Lei Xu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Yang
- Department of Cardiothoracic Surgery, Huangshi Central Hospital, Affiliated Hospital of Hubei Ploytechnic University, Edong Healthcare Group, Huangshi, China
| | - Zongfei Wang
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Haibo Sun
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xiankai Chen
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hounai Xie
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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13
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You J, Zhang H, Li W, Dai N, Zheng Z. Single versus double chest drains after pulmonary lobectomy: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:175. [PMID: 32690055 PMCID: PMC7372892 DOI: 10.1186/s12957-020-01945-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/03/2020] [Indexed: 12/25/2022] Open
Abstract
Background Previous randomized controlled trials have compared the efficacy and safety of single chest drain (SCD) and double chest drains (DCD) in the patients undergone pulmonary lobectomy, yet the results remain inconsistent. Therefore, we aimed to conduct this present systematic review and meta-analysis to evaluate the role of SCD and DCD in the patients undergone pulmonary lobectomy. Methods PubMed, Medline, EMBASE, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang, Weipu, and China Biomedical Literature databases were searched up to February 28, 2020, to identify the potential RCTs on SCD and DCD in the patients undergone pulmonary lobectomy. The main outcomes including verbal pain score, the duration of drainage (days), the length of hospital stay (days), and the incidence of air leak and re-drainage were collected and analyzed. All the data were processed and analyzed with software RevMan 5.3. We calculated and analyzed the odds ratios (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes. Results A total of 11 RCTs with 1214 patients were included, in which 589 patients received SCD treatment and 625 patients DCD treatment. The verbal pain score (MD = − 0.54, 95%CI (− 0.87, − 0.21)), the duration of drainage (MD = − 0.65, 95%CI (− 1.04, − 0.26)), and the length of hospital stay (MD = − 0.55, 95%CI (− 0.80, − 0.29)) in SCD group were significantly less than that of DCD group. There were no significant differences on the incidence of air leak (OR = 1.35, 95%CI (0.86, 2.11)) and re-drainage (OR = 0.88, 95%CI (0.41, 1.90)) among the two groups. Conclusions SCD is a safe option, and it has the advantages of less postoperative pain, shortened duration of drain, and reduced length of hospital stay when compared with DCD in the patients undergone pulmonary lobectomy.
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Affiliation(s)
- Jinzhi You
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Hailing Zhang
- The Suqian Clinical College of Xuzhou Medical University, Suqian, China
| | - Wei Li
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Ninghuang Dai
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Zhongfeng Zheng
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China.
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14
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Wen Y, Jiang Y, Liang H, Jiang L, Guo Z, Musonza C, Thomas RL, Yang C, He J, Shen J, Chen L, Sun H, Wright GM, Zhang J, Yang Q, Zhong S, Liang W, Li S, Zhang J, He J. Tubeless video-assisted thoracic surgery for lung cancer: is it ready for prime time? Future Oncol 2020; 16:1229-1234. [PMID: 32379503 DOI: 10.2217/fon-2020-0278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Yaokai Wen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China.,Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong 511436, PR China
| | - Yu Jiang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China.,Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong 511436, PR China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China
| | - Long Jiang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China
| | - Zhihua Guo
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China
| | - Clive Musonza
- Brown School at Washington University in St. Louis, St. Louis, Missouri 63130, USA
| | - R Lucas Thomas
- Washington University School of Medicine, St. Louis, Missouri 63110, USA.,University of Washington, Seattle, Washington 98195, USA
| | - Chenglin Yang
- Department of Thoracic Surgery, Shenzhen Center, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong 518116, PR China
| | - Jiaxi He
- University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang 317000, PR China
| | - Lei Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China.,Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China
| | - Haibo Sun
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, PR China
| | - Gavin M Wright
- Department of Surgery, University of Melbourne; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Department of Cardiothoracic Surgery, St. Vincent's Hospital, Melbourne, Victoria 3065, Australia.,Victorian Comprehensive Cancer Center, Melbourne, Victoria 3000, Australia
| | - Jian Zhang
- Thoracic Surgery Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, PR China
| | - Qintai Yang
- Department of Otorhinolaryngology-Head & Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, PR China
| | - Shengyi Zhong
- Department of Cardiothoracic Surgery, Xianning Central Hospital, Xianning, Wuhan 437100, PR China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China
| | - Shuben Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China
| | - Jianrong Zhang
- Brown School at Washington University in St. Louis, St. Louis, Missouri 63130, USA.,Victorian Comprehensive Cancer Center, Melbourne, Victoria 3000, Australia.,Department of General Practice, Melbourne Medical School; Cancer in Primary Care Research Group, Centre for Cancer Research, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China
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