1
|
Pfeuty K, Rojas D, Iquille J, Lenot B. Postoperative day 1 discharge following subxiphoid thoracoscopic anatomical lung resection: a single-centre, postoperative enhanced recovery experience. Eur J Cardiothorac Surg 2024; 65:ezae230. [PMID: 38857446 DOI: 10.1093/ejcts/ezae230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/29/2023] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES The goal of this study was to assess the safety and quality of recovery (QOR) after discharge on postoperative day (POD) 1 following subxiphoid thoracoscopic anatomical lung resection within an advanced Enhanced Recovery After Surgery (ERAS) program. METHODS A retrospective analysis of prospectively collected data was conducted. Characteristics, perioperative and outcome data, compliance with ERAS pathways and a home-transition QOR survey were analysed using a multivariable logistic regression model. RESULTS From January 2020 to January 2022, a total of 201 consecutive patients underwent subxiphoid multiportal thoracoscopic anatomical lung resection, comprising 108 lobectomies and 93 sublobar resections (SLRs) (59 complex SLRs and 34 simple SLRs). Among them, 113 patients (56%) were discharged on POD 1, 49% after a lobectomy, 59% after a simple sublobar resection and 68% after a complex sublobar resection. In the multivariable analysis, age > 74 years and duration of the operation were associated with discharge after POD 1, whereas forced expiratory volume in 1 s and complex SLRs were associated with discharge on POD 1. Chest tube removal was achieved on POD 0 in 58 patients (29%), and 138 patients (69%) were free from a chest tube on POD 1. There were 13% with in-hospital morbidity, 10% with 90-day readmission (7% after POD 1 discharge and 14% in patients discharged after POD 1), and 0.5% with 90-day mortality. Patients discharged on POD 1 showed better compliance with the ERAS pathway with early chest tube removal and opioid-free analgesia. The home-transition QOR survey reported a better experience of returning home after discharge on POD 1 and similar pain scores. CONCLUSIONS Postoperative day 1 discharge can be safely achieved in appropriately selected patients after subxiphoid thoracoscopic anatomical lung resection, with excellent outcomes and high quality of recovery, supported by early chest tube removal as a determinant ERAS pathway.
Collapse
Affiliation(s)
- Karel Pfeuty
- Department of Thoracic and Vascular Surgery, Yves Le Foll Hospital, Saint-Brieuc, France
| | - Dorian Rojas
- Department of Cardiovascular and Thoracic Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jules Iquille
- Department of Thoracic and Vascular Surgery, Yves Le Foll Hospital, Saint-Brieuc, France
| | - Bernard Lenot
- Department of Thoracic and Vascular Surgery, Yves Le Foll Hospital, Saint-Brieuc, France
| |
Collapse
|
2
|
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
| |
Collapse
|
3
|
Sueyoshi K, Merlini M, Otsubo K, Kojima F, Bando T. Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis. J Cardiothorac Surg 2024; 19:120. [PMID: 38481228 PMCID: PMC10935967 DOI: 10.1186/s13019-024-02620-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Early chest tube removal should be considered to enhance recovery after surgery. The current study aimed to provide a predictive algorithm for air leak episodes (ALE) and to create a knowledge base for early chest tube removal. METHODS This retrospective study enrolled patients who underwent thoracoscopic anatomical pulmonary resections in our unit. We defined ALE as any airflow ≥ 10 mL/min recorded in the follow-up charts based on the digital thoracic drainage device. Multivariate regression analysis was used to control for preoperative and intraoperative confounding factors. The ALE prediction algorithm was constructed by combining an additive ALE risk-scoring system using the coefficients of the significant predictive factors with the intraoperative water-sealing test. RESULTS In 485 consecutive thoracoscopic major pulmonary resections, ALE developed in 209 (43%) patients. Statistically significant ALE-associated preoperative factors included male sex, lower body mass index, radiologically evident emphysema, lobectomy, and upper lobe surgery. Significant ALE-associated intraoperative factors were incomplete fissure and pleural adhesion. The ALE risk scoring demonstrated an average area under the receiver operating characteristic curve of 0.72 in the fivefold cross-validation test. The ALE prediction algorithm correctly predicted ALE-absent patients at a negative predictive value of 80%. CONCLUSIONS The algorithm may promote the optimization of the chest tube-dwelling duration by identifying potential ALE-absent patients for accelerated tube removal.
Collapse
Affiliation(s)
- Kuniyo Sueyoshi
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| | - McAndrew Merlini
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| | - Kosuke Otsubo
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Toru Bando
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| |
Collapse
|
4
|
McCormack AJ, El Zaeedi M, Geraci TC, Cerfolio RJ. The process and safety of removing chest tubes 4 to 12 hours after robotic pulmonary lobectomy and segmentectomy. JTCVS OPEN 2023; 16:909-915. [PMID: 38204643 PMCID: PMC10775092 DOI: 10.1016/j.xjon.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/02/2023] [Accepted: 09/18/2023] [Indexed: 01/12/2024]
Abstract
Objective Chest tubes cause pain and morbidity. Methods This is a quality initiative study and review of patients who underwent robotic pulmonary resection by 1 surgeon (R.J.C.). The goal was to remove chest tubes within 4 to 12 hours after robotic segmentectomy and lobectomy. Primary outcome was removal without the need for reinsertion, thoracentesis, or any morbidity due to early removal of the chest tube. Secondary outcomes were symptomatic pneumothorax, pleural effusion, chylothorax, subcutaneous emphysema, and chest tube reinsertion or thoracentesis within 60 days of surgery. Results Between January 2018 and December 2022, 590 patients underwent robotic lobectomy or segmentectomy. Chest tubes were removed within 4 to 12 hours postoperatively in 63.5% of patients (375/590). In 2022, this was achieved in 91% after lobectomy (119/128) and 94% after segmentectomy (75/80). There were significantly more chest tubes removed within 4 to 12 hours postoperatively from 2020 to 2022 than pre-2020 (P < .001). Forty patients (6.8%) were discharged home on postoperative day 1 with a chest tube. Sixteen patients (2.7%) had post-chest tube removal increasing pneumothorax and subcutaneous emphysema; none required tube reinsertion. There was no 30-day or 90-day mortality. Twelve patients (2%) had an outpatient thoracentesis for effusion within 60 days. Twenty patients (3.3%) were readmitted, none seemingly related to effusions. Nonsmokers (P = .04) and segmentectomy (P = .001) were associated with chest tube removal within 4 to 12 hours of surgery. Conclusions Chest tubes can be safely removed within 4 to 12 hours after robotic segmentectomy and lobectomy. Factors associated with successful early chest tube removal are nonsmoking, segmentectomy, and team members becoming comfortable with the process.
Collapse
Affiliation(s)
| | - Mohamed El Zaeedi
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Travis C. Geraci
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | | |
Collapse
|
5
|
Igai H, Matsuura N, Numajiri K, Ohsawa F, Kamiyoshihara M. Early chest drain removal on the day of uniportal thoracoscopic segmentectomy. Gen Thorac Cardiovasc Surg 2023; 71:700-707. [PMID: 37452220 DOI: 10.1007/s11748-023-01951-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Although early removal of postoperative chest drains can facilitate recovery, it can be difficult to achieve in segmentectomy due to the management of air leakage in intersegmental planes. This study prospectively examined the feasibility of drain removal on the same day of uniportal thoracoscopic segmentectomy. METHODS Twenty patients who underwent uniportal thoracoscopic segmentectomy between July 2021 and May 2022 were enrolled in this prospective study. The indications for drain removal on the day of surgery were absence of air leakage in an intraoperative sealing test, radiographic evidence of lung expansion, and continuous absence of air leakage via a drainage bottle for 4 h after the operation. The primary endpoint was rate of the patients who required re-drainage after the postoperative drainage tube was removed on the day of surgery. The secondary end points were postoperative pain evaluated using a numerical rating scale on postoperative days 1, 7, and 28; morbidity; and postoperative hospitalization period. RESULTS Fifteen patients successfully underwent drain removal on the day of surgery. None required re-drainage. The mean postoperative hospitalization period was 2.3 ± 1.7 days. Overall, 12 of the 15 (80%) patients were discharged on postoperative day 1 or 2. The mean numerical rating scale scores were 1.2 ± 1.6, 0.4 ± 0.7, and 0.4 ± 1.5 on postoperative days 1, 7, and 28, respectively. CONCLUSION In uniportal thoracoscopic segmentectomy, drain removal on the day of surgery is feasible and may reduce pain on postoperative day 1.
Collapse
Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan.
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan
| | - Kazuki Numajiri
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan
| |
Collapse
|
6
|
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
| |
Collapse
|
7
|
Feasibility of tubeless thoracoscopic bullectomy in primary spontaneous pneumothorax patients. Gen Thorac Cardiovasc Surg 2023; 71:138-144. [PMID: 36036321 DOI: 10.1007/s11748-022-01869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/19/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Although early removal of postoperative chest drains can facilitate postoperative recovery, there are risks of undetected bleeding and a need for re-drainage to treat delayed pulmonary air leaks. In this study, we aimed to prospectively examine the feasibility of tubeless thoracoscopic bullectomy in primary spontaneous pneumothorax (PSP) patients. METHODS Between January 2021 and November 2021, 30 PSP patients were enrolled in this prospective study. The absence of air leakage was confirmed and radiographic evidence of lung expansion was acquired; the tube was then removed in the operating room. The primary endpoint was postoperative air leakage requiring re-drainage among patients who underwent tube removal in the operating room. The secondary endpoints were postoperative pain (numerical rating scale) on postoperative days (PODs) 1, 7, and 28, morbidity, and postoperative hospitalization time. RESULTS Four (13.3%) patients were excluded because of underlying pulmonary disease (n = 2) and air leaks (n = 2) detected in the operating room. Chest drainage tubes were removed in the operating room for the remaining 26 patients; none of them required re-drainage. The mean postoperative hospitalization time was 1.2 ± 0.4 days. The mean numerical rating scale scores were 4.2 ± 2 (median: 4.5), 1.6 ± 1.6 (median: 1), and 0.4 ± 0.8 (median: 0) on PODs 1, 7, and 28, respectively. Only one case of hemoptysis occurred as a postoperative complication. CONCLUSIONS Tubeless thoracoscopic bullectomy for PSP is feasible and may reduce the postoperative hospitalization time; however, it does not significantly reduce pain on POD1.
Collapse
|
8
|
Hong JI, Lee JH, Kim HK. Early Pleurodesis for Postoperative Air Leak with Autologous Blood and 50% Glucose Solution. J Chest Surg 2023; 56:16-22. [PMID: 36530129 PMCID: PMC9845852 DOI: 10.5090/jcs.22.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/21/2022] [Accepted: 11/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background Postoperative air leaks after pulmonary resection prolong the duration of chest drainage and the length of hospital stay. One of the many treatment options is bedside pleurodesis using various agents. This study evaluated the feasibility of an early intervention to stop postoperative air leaks with either autologous blood or a 50% glucose solution. Methods We retrospectively reviewed 323 patients who underwent bedside pleurodesis between January 2017 and March 2022. Sixty-four patients received autologous blood patch pleurodesis, and 36 were treated with a 50% glucose solution after pulmonary resection. The primary endpoints were the total postoperative tube indwelling time, post-pleurodesis tube indwelling time, and hospital stay. A propensity score-matched analysis was performed. Results In the autologous blood patch pleurodesis and 50% glucose solution groups, the mean initiation timing of postoperative pleurodesis were 2.06±1.62 and 3.28±1.56 days, the mean duration of the tube indwelling time after surgery was 6.58±3.02 and 6.42±4.92 days, and the mean duration of the tube indwelling time after pleurodesis, it was 4.53±3.10 and 3.11±4.80 days, respectively. In addition, the total length of hospital stay was 9.11±5.42 and 7.83±4.75 days in the autologous blood patch pleurodesis and 50% glucose solution groups, respectively. Conclusion Early postoperative air leak cessation with autologous blood patch pleurodesis or 50% glucose solution pleurodesis is a feasible procedure with acceptable outcomes that effectively shortens the hospital stay.
Collapse
Affiliation(s)
- Jeong In Hong
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea,Corresponding author Hyun Koo Kim Tel 82-2-2626-3106 Fax 82-2-866-6377 E-mailORCIDhttps://orcid.org/0000-0001-7604-4729 See Commentary page 23
| |
Collapse
|