1
|
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
|
2
|
Hentati A, Ayed AB, Jdidi J, Chaari Z, Halima GB, Frikha I. Enhanced recovery after thoracic surgery in low- and middle-income countries: Feasibility and outcomes. Asian Cardiovasc Thorac Ann 2024; 32:27-35. [PMID: 37993978 DOI: 10.1177/02184923231216131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) applies multimodal, perioperative, and evidence-based practices to decrease postoperative morbi-mortality, the length of hospital stay, and hospitalization costs. Implementing enhanced recovery after thoracic surgery (ERATS) in low- and middle-income countries (LMIC) is problematic. This randomized controlled trial evaluated the feasibility and effectiveness of an ERATS protocol adapted to LMIC conditions in Tunisia. MATERIALS AND METHODS We conducted this randomized controlled trial between December 2015 and August 2017 in the Thoracic and Cardiovascular Surgery Department at Habib Bourguiba University Hospital of Sfax, Tunisia. RESULTS One hundred patients undergoing thoracic surgery were randomly allocated to the ERATS group or Control group. During the postoperative phase, 13 patients (13%) were excluded secondary. These complication rates were lower in the ERATS group: lack of reexpansion (14.63% vs 16.10%: p = 0.72), pleural effusion (0% vs 10.86%, p = 0.05), and prolonged air leak (17.07% vs 30.43%, p = 0.14). The pain level decreased significantly in the ERATS group from postoperative H3 (p = 0.006). This difference was significant at H6 (p = 0.001), H24 (p = 0.05), H48 (p = 0.01), discharge (p = 0.002), and after 15 days (p = 0.01), with a decreased analgesic consumption. The length of hospital stay was shorter in the ERAS group (median six days vs seven days, p = 0.17). CONCLUSION This study provides an adapted ERATS protocol, applicable regardless of the surgical approach or the type of resection and suitable for LMIC hospital's conditions. This protocol can improve the postoperative outcomes of thoracic surgery.
Collapse
Affiliation(s)
- Abdessalem Hentati
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Department of Cardiovascular and Thoracic Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ahmed Ben Ayed
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Surgery Department, Gabes University Hospital, Gabes, Tunisia
| | - Jihen Jdidi
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Community Medicine Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Zied Chaari
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Department of Cardiovascular and Thoracic Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ghassen Ben Halima
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Department of Cardiovascular and Thoracic Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imed Frikha
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
- Department of Cardiovascular and Thoracic Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| |
Collapse
|
3
|
Liu X, Wang X, Sheng J, Jiang Y, Li L, Dai X. Open decortication for patients presenting with stage III tuberculous empyema with low density lines on CT imaging. Sci Rep 2023; 13:9658. [PMID: 37316645 DOI: 10.1038/s41598-023-36420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/03/2023] [Indexed: 06/16/2023] Open
Abstract
To explore the influence of CT findings on the optimal timing of open decorticationin patients with stage III tuberculous empyema. A total of 80 patients with stage III tuberculous empyema who had undergone open decortications were recruited; 44 patients had chest CT findings indicating low-density lines, while 36 patients did not show this imaging finding. Demographic data, perioperative data and preoperative and postoperative chest CT images were collected. In the low-density line group, the duration of disease (P = 0.0030) and the preoperative anti-tuberculosis time (P = 0.0016) were longer than those of the group without low-density lines, and the ESR (P = 0.0218), CRP (P = 0.0027) and leukocyte count (P = 0.0339) were lower in the low-density line group. Additionally, in the median operative time (P = 0.0003), intraoperative blood loss (P < 0.0001), volume of catheter drainage during 48 h after operation (P = 0.0067), chest tube duration (P < 0.0001), and length of hospital stay (P = 0.0154) were significantly lower in the low-density line group than in the group without low-density lines. A total of 88.64% of participants in the low-density line group showed hyperplasia with hyaline degeneration in pathological examination, which was observed only in 41.67% of patients without low-density lines. In addition, gaseous necrosis was considerably higher in patients without a low-density line (P = 0.004), while the low-density line group had a higher rate of treatment success (P < 0.05). Patients with stage III tuberculous empyema presenting with low-density lines around the thickened fibrous pleural rind on preoperative CT imaging may be good candidates for open decortication.
Collapse
Affiliation(s)
- Xiaoyu Liu
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, 430030, Hubei, China
| | - Xuan Wang
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, 430030, Hubei, China
| | - Jian Sheng
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, 430030, Hubei, China
| | - Yuhui Jiang
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, 430030, Hubei, China
| | - Li Li
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, 430030, Hubei, China.
| | - Xiyong Dai
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, 430030, Hubei, China.
| |
Collapse
|
4
|
Yang Z, Chang X. A 2.5-cm single-port video-assisted thoracoscopic surgery for stage III tuberculous empyema: a case report. J Cardiothorac Surg 2023; 18:15. [PMID: 36627632 PMCID: PMC9832621 DOI: 10.1186/s13019-023-02116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Stage III tuberculous empyema is a common disease of tuberculosis. Traditionally, it has been treated by thoracotomy or video-assisted thoracoscopic surgery with two to four incisions. But conventional surgery has large trauma, large bleeding volume and long recovery time. To our knowledge it is the first report of surgery for stage III tuberculous empyema with a mini single-port approach. CASE PRESENTATION A 23-year-old woman admitted to our hospital with complaints of intermittent chest pain for half a year. We got the diagnosis of stage III tuberculous empyema after medical treatment. Considering that the patient was young and unmarried, we decided to perform minimally invasive pleural decortication through a 2.5 cm single port. The operation time was 240 min, and blood loss was 100 ml. The patient recovered well and postoperative pain was mild. CONCLUSION This case demonstrates that single-port VATS with a smaller incision for the Stage III tuberculous empyema should be considered in well selected patients.
Collapse
Affiliation(s)
- Zhi Yang
- grid.24696.3f0000 0004 0369 153XDepartment of Thoracic Surgery, Beijing Chest Hospital Affiliated to Capital Medical University, Courtyard 9, Beiguan Street, Tongzhou District, Beijing, China
| | - Xiujun Chang
- grid.24696.3f0000 0004 0369 153XDepartment of Thoracic Surgery, Beijing Chest Hospital Affiliated to Capital Medical University, Courtyard 9, Beiguan Street, Tongzhou District, Beijing, China
| |
Collapse
|
5
|
Leonardi B, Sagnelli C, Fiorelli A, Leone F, Mirra R, Pica DG, Di Filippo V, Capasso F, Messina G, Vicidomini G, Sica A, Santini M. Application of ERAS Protocol after VATS Surgery for Chronic Empyema in Immunocompromised Patients. Healthcare (Basel) 2022; 10:healthcare10040635. [PMID: 35455813 PMCID: PMC9029650 DOI: 10.3390/healthcare10040635] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/13/2022] [Accepted: 03/24/2022] [Indexed: 02/05/2023] Open
Abstract
Enhanced recovery after surgery protocols have shown improved clinical outcomes after lung resection surgery, but their application after empyema surgery is still limited. We retrospectively evaluated the outcomes of an adapted enhanced recovery after surgery (ERAS) protocol for immunocompromised patients who underwent video-assisted thoracoscopic surgery (VATS) surgery for chronic empyema between December 2013 and December 2021. The patients were divided into an ERAS group and a conventional treatment group. Peri-operative data were collected and compared between the two groups. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative pain and post-operative complications (air leaks, atelectasis). A total of 86 patients, 45 in the ERAS group and 41 in the non-ERAS group, were considered. Chest tube duration (6.4 ± 2.3 vs. 13.6 ± 6.8 days) and post-operative length of stay (7.6 ± 1.6 vs. 16.9 ± 6.9 days) were significantly shorter in the ERAS group. The volume of chest drainage (103 ± 78 vs. 157 ± 89 mL/day) was significantly smaller in the ERAS group. There were no significant differences in operative time, blood loss, need for transfusion, tube reinsertion and median VAS score. The incidence of air leaks and atelectasis was significantly reduced in the ERAS group, as was the need for bronchoscopic aspiration. The application of an ERAS protocol after empyema VATS surgery for immunocompromised patients improved the surgical outcome, reducing the post-operative length of stay and rate of complications.
Collapse
Affiliation(s)
- Beatrice Leonardi
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Alfonso Fiorelli
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
- Correspondence: ; Tel.: +39-33-8103-0061
| | - Francesco Leone
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Rosa Mirra
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Davide Gerardo Pica
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Vincenzo Di Filippo
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Francesca Capasso
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Gaetana Messina
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Giovanni Vicidomini
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Mario Santini
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| |
Collapse
|