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Mei Z, Khalil MA, Guo Y, Li D, Banerjee A, Taheri M, Kratzmeier CM, Chen K, Lau CL, Luzina IG, Atamas SP, Kandasamy S, Kreisel D, Gelman AE, Jacobsen EA, Krupnick AS. Stress-induced eosinophil activation contributes to postoperative morbidity and mortality after lung resection. Sci Transl Med 2024; 16:eadl4222. [PMID: 39167663 DOI: 10.1126/scitranslmed.adl4222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 07/31/2024] [Indexed: 08/23/2024]
Abstract
Respiratory failure occurs more frequently after thoracic surgery than abdominal surgery. Although the etiology for this complication is frequently attributed to underlying lung disease present in patients undergoing thoracic surgery, this notion is often unfounded because many patients with normal preoperative pulmonary function often require prolonged oxygen supplementation even after minimal resection of lung tissue. Using a murine model of pulmonary resection and peripheral blood samples from patients undergoing resection of the lung or abdominal organs, we demonstrated that lung surgery initiates a proinflammatory loop that results in damage to the remaining lung tissue, noncardiogenic pulmonary edema, hypoxia, and even death. Specifically, we demonstrated that resection of murine lung tissue increased concentrations of the homeostatic cytokine interleukin-7, which led to local and systemic activation of type 2 innate lymphoid cells. This process activated lung-resident eosinophils and facilitated stress-induced eosinophil maturation in the bone marrow in a granulocyte-macrophage colony-stimulating factor-dependent manner, resulting in systemic eosinophilia in both mice and humans. Up-regulation of inducible nitric oxide synthase in lung-resident eosinophils led to tissue nitrosylation, pulmonary edema, hypoxia, and, at times, death. Disrupting this activation cascade at any stage ameliorated deleterious outcomes and improved survival after lung resection in the mouse model. Our data suggest that repurposing US Food and Drug Administration-approved eosinophil-targeting strategies may potentially offer a therapeutic intervention to improve outcomes for patients who require lung resection for benign or malignant etiology.
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Affiliation(s)
- Zhongcheng Mei
- Department of Surgery, University of Maryland, Baltimore, MD 21201, USA
| | - May A Khalil
- Department of Surgery, University of Maryland, Baltimore, MD 21201, USA
| | - Yizhan Guo
- Department of Surgery, University of Maryland, Baltimore, MD 21201, USA
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Dongge Li
- Department of Surgery, University of Maryland, Baltimore, MD 21201, USA
| | - Anirban Banerjee
- Department of Surgery, University of Maryland, Baltimore, MD 21201, USA
| | - Mojtaba Taheri
- Department of Surgery, University of Maryland, Baltimore, MD 21201, USA
| | | | - Kelly Chen
- Department of Surgery, University of Maryland, Baltimore, MD 21201, USA
| | - Christine L Lau
- Department of Surgery, University of Maryland, Baltimore, MD 21201, USA
| | - Irina G Luzina
- Department of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Sergei P Atamas
- Department of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | | | - Daniel Kreisel
- Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, MO 63110, USA
- Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Andrew E Gelman
- Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, MO 63110, USA
- Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Elizabeth A Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Alexander Sasha Krupnick
- Department of Surgery, University of Maryland, Baltimore, MD 21201, USA
- Department of Microbiology and Immunology, University of Maryland, Baltimore, MD 21201, USA
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Kagimoto A, Ishida M, Mimura T. Significance of the Goddard Score in Predicting Complications Related to Air Leak After Lobectomy. Ann Thorac Surg 2024; 118:233-239. [PMID: 37858880 DOI: 10.1016/j.athoracsur.2023.10.010] [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: 03/16/2023] [Revised: 08/30/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Postoperative air leakage is a frequent complication after lung resection, and emphysema is a risk factor. However, no study has investigated the relationship between emphysema severity and postoperative complications related to air leak by the Goddard score (GS), a visual evaluation method of radiologic emphysema using computed tomography. METHODS This study included patients who underwent lobectomy for non-small cell lung cancer between April 2009 and March 2022. The utility of GS in predicting complications related to air leak (air leak prolonged for ≥5 days, pleurodesis, and reoperation for air leak) was investigated by receiver operating characteristic curve analysis and multivariable analysis with a logistic regression model. RESULTS This study included 477 patients. The GS was a significant predictor of complications related to air leak (area under the curve, 0.696; P < .001). Based on the receiver operating characteristic curve analysis, GS of 6 points was used as the cutoff point for multivariable analysis. In the multivariable analysis, GS of ≥6 points was a significant predictor of complications related to air leak (odds ratio, 2.719; P = .007). In the subgroup analysis of patients with emphysema, GS of ≥6 points was a significant predictor of complications related to air leak (P = .014). CONCLUSIONS The GS was useful in predicting complications related to air leak. Patients with radiologic findings of emphysema with GS of ≥6 points should be recognized as a high-risk group for complications related to air leak.
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Affiliation(s)
- Atsushi Kagimoto
- Department of General Thoracic Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Masayuki Ishida
- Department of General Thoracic Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Takeshi Mimura
- Department of General Thoracic Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan.
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Qiu L, Zhao L, Wang B, Yang L, Cao C, Lv M, Xu M, Hou M, Wang X, Wang Y, Gu CP. Predicting the association of different levels of physical activity on postoperative pulmonary complications using the international physical activity questionnaire in patients undergoing thoracoscopic lung surgery under general anaesthesia: protocol for a prospective cohort study. BMJ Open 2024; 14:e077183. [PMID: 38749692 PMCID: PMC11097810 DOI: 10.1136/bmjopen-2023-077183] [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: 06/27/2023] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Postoperative pulmonary complications (PPCs) occur frequently in patients undergoing lung surgery under general anaesthesia and are strongly associated with longer postoperative hospital stays and increased mortality. The existing literature has shown that a higher level of preoperative physical activity (PA) plays a positive role in the low incidence of postoperative complications and the quality of life in patients undergoing lung surgery. However, the association between preoperative PA levels and the incidence of PPCs has rarely been studied, particularly in thoracoscopic lung surgery. This study aims to evaluate PA levels in patients undergoing thoracoscopic lung surgery using the International Physical Activity Questionnaire and to investigate the association between PA levels and the incidence of PPCs. METHODS AND ANALYSIS A total of 204 participants aged 18-80 years undergoing thoracoscopic lung surgery (thoracoscopic wedge resection, thoracoscopic segmentectomy and thoracoscopic lobectomy) will be included in the study. The primary outcome is the incidence of PPCs within the first 5 postoperative days. The secondary outcomes include the number of PPCs, the incidence of PPCs 1 month postoperatively, the arterial blood levels of inflammatory markers, the incidence of postoperative adverse events within the first 5 postoperative days, extubation time, unplanned admission to the intensive care unit, postoperative length of stay and mortality 1 month postoperatively. ETHICS AND DISSEMINATION The study was reviewed and approved by the Research Ethics Committee of the First Affiliated Hospital of Shandong First Medical University on 31 March 2022 (YXLL-KY-2022(014)) and is registered at ClinicalTrials.gov. We plan to disseminate the data and findings of this study in international and peer-reviewed journals. TRIAL REGISTRATION NUMBER The trial has been prospectively registered at the clinicaltrials.gov registry (NCT05401253).
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Affiliation(s)
- Lei Qiu
- Weifang Medical University, Weifang, Shandong, China
| | - Liang Zhao
- Shandong University, Jinan, Shandong, China
| | - Bailun Wang
- Shandong First Medical University, Jinan, Shandong, China
| | - Li Yang
- Shandong First Medical University, Jinan, Shandong, China
| | - Cuicui Cao
- Shandong First Medical University, Jinan, Shandong, China
| | - Meng Lv
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Mengchao Xu
- Shandong First Medical University, Jinan, Shandong, China
| | - Ming Hou
- The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Xiaofei Wang
- The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Yuelan Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Chang Ping Gu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Tanaka T, Murakami J, Yoshimine S, Yamamoto N, Ueda K, Suzuki R, Kurazumi H, Hamano K. Effectiveness of Stitch With Pledget to Prevent Prolonged Air Leak in Thoracoscopic Lung Resection. J Surg Res 2024; 296:589-596. [PMID: 38340493 DOI: 10.1016/j.jss.2024.01.022] [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] [Received: 12/21/2022] [Revised: 12/30/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION We previously demonstrated the usefulness of combining stitching with covering to seal alveolar air leaks in an animal model. This study aimed to clarify the effectiveness and feasibility of this sealing method in the clinical setting. METHODS Data of 493 patients who underwent thoracoscopic anatomical resection between 2013 and 2020 for lung cancer were retrospectively reviewed. Prolonged air leak was defined as chest drain placement lasting 5 d or longer due to air leak. Until July 2017 (early study period), we covered air leaks using mesh. However, for sealing (late study period), we additionally stitched leaks with pledget in patients at high risk of prolonged air leak. The pneumostasis procedure, intraoperative confirmation test of pneumostasis, and chest tube management were uniform during both periods. RESULTS The incidence of prolonged air leak was significantly lower in the late than in the early period (3.6% versus 12.5%), whereas pulmonary emphysema was more severe in the late period compared to the early period. Intraoperative failure of sealing air leaks was significantly reduced in the late period than in the early period. In both univariate and propensity score matching analysis, the study period was a significant predictor of prolonged air leak. CONCLUSIONS The combination of stitching and covering with mesh may contribute to reducing prolonged air leak incidence in patients undergoing thoracoscopic anatomical lung resection for lung cancer.
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Affiliation(s)
- Toshiki Tanaka
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
| | - Junichi Murakami
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Sota Yoshimine
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Naohiro Yamamoto
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kazuhiro Ueda
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Dental and Medical Sciences, Kagoshima, Japan
| | - Ryo Suzuki
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hiroshi Kurazumi
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Pluchart H, Chanoine S, Moro-Sibilot D, Chouaid C, Frey G, Villa J, Degano B, Giaj Levra M, Bedouch P, Toffart AC. Lung cancer, comorbidities, and medication: the infernal trio. Front Pharmacol 2024; 14:1016976. [PMID: 38450055 PMCID: PMC10916800 DOI: 10.3389/fphar.2023.1016976] [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: 08/11/2022] [Accepted: 09/25/2023] [Indexed: 03/08/2024] Open
Abstract
Most patients with lung cancer are smokers and are of advanced age. They are therefore at high risk of having age- and lifestyle-related comorbidities. These comorbidities are subject to treatment or even polypharmacy. There is growing evidence of a link between lung cancer, comorbidities and medications. The relationships between these entities are complex. The presence of comorbidities and their treatments influence the time of cancer diagnosis, as well as the diagnostic and treatment strategy. On the other hand, cancer treatment may have an impact on the patient's comorbidities such as renal failure, pneumonitis or endocrinopathies. This review highlights how some comorbidities may have an impact on lung cancer presentation and may require treatment adjustments. Reciprocal influences between the treatment of comorbidities and anticancer therapy will also be discussed.
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Affiliation(s)
- Hélène Pluchart
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC UMR5525, Grenoble, France
| | - Sébastien Chanoine
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
| | - Denis Moro-Sibilot
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Inserm U955, UPEC, IMRB, équipe CEpiA, CréteilFrance
| | - Gil Frey
- Service de Chirurgie Thoracique, Vasculaire et Endocrinienne, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Julie Villa
- Service de Radiothérapie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- Université Grenoble Alpes, Grenoble, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France
| | - Matteo Giaj Levra
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Pierrick Bedouch
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC UMR5525, Grenoble, France
| | - Anne-Claire Toffart
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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Fu M, Xu R, Chen G, Zheng X, Shu B, Huang H, Duan G, Chen Y. Postoperative esketamine improves ventilation after video-assisted thoracoscopic lung resection: A double-blinded randomized controlled trial. Heliyon 2024; 10:e25100. [PMID: 38322862 PMCID: PMC10844121 DOI: 10.1016/j.heliyon.2024.e25100] [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: 11/26/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 02/08/2024] Open
Abstract
Background Pain management after lung resection plays a crucial role in reducing postoperative pulmonary complications (PPCs). This study aimed to examine the effect of postoperative esketamine infusion as an adjunct to opioid analgesia on ventilation and pulmonary complications in patients underwent lung resection. Methods Patients undergoing video-assisted thoracoscopic lung resection were randomly assigned to either the esketamine group or the control group. The esketamine group received a 24-h infusion of 1.5 mcg/ml sufentanil combined with 0.75 mcg/ml esketamine after surgery, while the control group received 1.5 mcg/ml sufentanil alone. The primary outcome measure was low minute ventilation, and the secondary outcome measures were hypoxemia, PaO2/FiO2 levels, postoperative pulmonary complications, hospital stay duration, ambulation time, Visual Analogue Scale (VAS) score, depression and anxiety levels, sleep quality, and analgesia satisfaction. Results 80 patients were randomly divided into two groups: the esketamine group (n = 40) and the control group (n = 40). The esketamine group exhibited notably reduced incidence of low minute ventilation (P = 0.014), lower occurrence of postoperative pulmonary complications (PPCs) compared to the control group (P = 0.039), and decreased incidence of hypoxemia (P = 0.003). Furthermore, the esketamine group showed improved outcomes with lower VAS scores on the second postoperative day and enhanced sleep quality (P < 0.001) after the surgery. Conclusions Postoperative esketamine infusion with opioids improved ventilation and reduced PPCs after lung resection, warranting further clinical studies. Trial registration This study was registered on ClinicalTrials.gov (Trial ID: NCT05458453, https://clinicaltrials.gov/ct2/show/NCT05458453).
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Affiliation(s)
| | | | - Guizhen Chen
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xuemei Zheng
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Bin Shu
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - He Huang
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guangyou Duan
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuanjing Chen
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Piccioni F, Rosboch GL, Coccia C, Donati I, Proto P, Ceraolo E, Pierconti F, Pagano M, Vernocchi D, Valenza F, Rocca GD. Decurarization After Thoracic Anesthesia using sugammadex compared to neostigmine (DATA trial): a multicenter randomized double-blinded controlled trial. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:9. [PMID: 38331969 PMCID: PMC10854138 DOI: 10.1186/s44158-024-00146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Thoracic surgery is a high-risk surgery especially for the risk of postoperative pulmonary complications. Postoperative residual paralysis has been shown to be a risk factor for pulmonary complications. Nevertheless, there are few data in the literature concerning the use of neuromuscular blocking agent antagonists in patients undergoing lung surgery. METHODS Seventy patients were randomized in three Italian centers to receive sugammadex or neostigmine at the end of thoracic surgery according to the depth of the residual neuromuscular block. The primary outcome was the time from reversal administration to a train-of-four ratio (TOFR) of 0.9. Secondary outcomes were the time to TOFR of 1.0, to extubation, to postanesthesia unit (PACU) discharge, postoperative complications until 30 days after surgery, and length of hospital stay. RESULTS Median time to recovery to a TOFR of 0.9 was significantly shorter in the sugammadex group compared to the neostigmine one (88 vs. 278 s - P < 0.001). The percentage of patients who recovered to a TOFR of 0.9 within 5 min from reversal administration was 94.4% and 58.8% in the sugammadex and neostigmine groups, respectively (P < 0.001). The time to extubation, but not the PACU stay time, was significantly shorter in the sugammadex group. No differences were found between the study groups as regards postoperative complications and length of hospital stay. The superiority of sugammadex in shortening the recovery time was confirmed for both deep/moderate and shallow/minimal neuromuscular block. CONCLUSIONS Among patients undergoing thoracic surgery, sugammadex ensures a faster recovery from the neuromuscular block and earlier extubation compared to neostigmine.
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Affiliation(s)
- Federico Piccioni
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
- Anesthesia and Intensive Care Unit, IRCCS Fondazione Istituto Nazionale Dei Tumori, Milan, Italy.
| | - Giulio L Rosboch
- Anesthesia and Intensive Care, Dipartimento Di Anestesia, Rianimazione Ed Emergenze AOU Città Della Salute E Della Scienza, Turin, Italy
| | - Cecilia Coccia
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ilaria Donati
- Anesthesia and Intensive Care Unit, IRCCS Fondazione Istituto Nazionale Dei Tumori, Milan, Italy
- Anesthesia Unit, AUSL Modena Area Sud, Modena, Italy
| | - Paolo Proto
- Anesthesia and Intensive Care Unit, IRCCS Fondazione Istituto Nazionale Dei Tumori, Milan, Italy
| | - Edoardo Ceraolo
- Anesthesia and Intensive Care, Dipartimento Di Anestesia, Rianimazione Ed Emergenze AOU Città Della Salute E Della Scienza, Turin, Italy
| | - Federico Pierconti
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Martina Pagano
- School of Anesthesia and Intensive Care, University of Milan, Milan, Italy
| | - Daniele Vernocchi
- School of Anesthesia and Intensive Care, Humanitas University, Milan, Italy
| | - Franco Valenza
- Anesthesia and Intensive Care Unit, IRCCS Fondazione Istituto Nazionale Dei Tumori, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
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He J, Han D, Qian K, Guan W, Zhang G, Lu W, Li H, Zhi X. Smoking cessation in Chinese patients undergoing thoracic surgery: A multicenter prospective observational study. Tob Induc Dis 2024; 22:TID-22-06. [PMID: 38204733 PMCID: PMC10777477 DOI: 10.18332/tid/175639] [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: 09/07/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION The multicenter CHAMPION study aimed to assess the impact of smoking cessation on post-operative complications (PCs) and smoking cessation patterns in Chinese patients undergoing lung surgery. METHODS Patients undergoing elective lung surgery were prospectively enrolled from three major tertiary centers in China. Patients were categorized as smokers or quitters before surgery. Baseline characteristics and smoking status were analyzed. The incidence of PCs and pulmonary PCs (PPCs), smoking relapse rate, and causes within six months post-operatively were investigated. The questionnaire was conducted in all patients and 30 healthcare professionals (HCPs), regarding the awareness and effectiveness of smoking cessation methods. RESULTS Of the 276 enrolled patients, 213 (77.2%) were smokers and 63 (22.8%) were quitters; 76.4% were diagnosed with primary lung cancer. PCs occurred in 13.8% of patients, with similar proportions in smokers (14.1%) and quitters (12.7%). PPCs occurred in 9.8% of patients with no significant differences between smokers and quitters (9.4% vs 11.1%, p=0.70). At six months, 9.2% of patients relapsed, with a lower rate in quitters compared to smokers (3.3% vs 11.0%, p=0.01). HCPs exhibited higher awareness of smoking cessation methods than patients. Perceived effectiveness of smoking cessation methods from the patients were low. CONCLUSIONS In patients undergoing lung surgery with a low risk of PCs, active smoking does not significantly increase the risk of PCs or PPCs relative to quitters, suggesting that there is likely no need to postpone lung surgery for those who have not yet quit smoking. However, further large-scale studies are necessary to confirm these findings.
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Affiliation(s)
- Jianxing He
- Department of Thoracic Surgery, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Dingpei Han
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Qian
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weijie Guan
- Department of Thoracic Surgery, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Ge Zhang
- Lung Cancer Initiative, Johnson & Johnson Enterprise Innovation, Shanghai, China
| | - Weiqing Lu
- Lung Cancer Initiative, Johnson & Johnson Enterprise Innovation, Shanghai, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Piccioni F, Langiano N, Bignami E, Guarnieri M, Proto P, D'Andrea R, Mazzoli CA, Riccardi I, Bacuzzi A, Guzzetti L, Rossi I, Scolletta S, Comi D, Benigni A, Pierconti F, Coccia C, Biscari M, Murzilli A, Umari M, Peratoner C, Serra E, Baldinelli F, Accardo R, Diana F, Fasciolo A, Amodio R, Ball L, Greco M, Pelosi P, Della Rocca G. One-Lung Ventilation and Postoperative Pulmonary Complications After Major Lung Resection Surgery. A Multicenter Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2023; 37:2561-2571. [PMID: 37730455 PMCID: PMC10133024 DOI: 10.1053/j.jvca.2023.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES The effect of one-lung ventilation (OLV) strategy based on low tidal volume (TV), application of positive end-expiratory pressure (PEEP), and alveolar recruitment maneuvers (ARM) to reduce postoperative acute respiratory distress syndrome (ARDS) and pulmonary complications (PPCs) compared with higher TV without PEEP and ARM strategy in adult patients undergoing lobectomy or pneumonectomy has not been well established. DESIGN Multicenter, randomized, single-blind, controlled trial. SETTING Sixteen Italian hospitals. PARTICIPANTS A total of 880 patients undergoing elective major lung resection. INTERVENTIONS Patients were randomized to receive lower tidal volume (LTV group: 4 mL/kg predicted body weight, PEEP of 5 cmH2O, and ARMs) or higher tidal volume (HTL group: 6 mL/kg predicted body weight, no PEEP, and no ARMs). After OLV, until extubation, both groups were ventilated using a tidal volume of 8 mL/kg and a PEEP value of 5 cmH2O. The primary outcome was the incidence of in-hospital ARDS. Secondary outcomes were the in-hospital rate of PPCs, major cardiovascular events, unplanned intensive care unit (ICU) admission, in-hospital mortality, ICU length of stay, and in-hospital length of stay. MEASUREMENTS AND MAIN RESULTS ARDS occurred in 3 of 438 patients (0.7%, 95% CI 0.1-2.0) and in 1 of 442 patients (0.2%, 95% CI 0-1.4) in the LTV and HTV group, respectively (Risk ratio: 3.03 95% CI 0.32-29, p = 0.372). Pulmonary complications occurred in 125 of 438 patients (28.5%, 95% CI 24.5-32.9) and in 136 of 442 patients (30.8%, 95% CI 26.6-35.2) in the LTV and HTV group, respectively (risk ratio: 0.93, 95% CI 0.76-1.14, p = 0.507). The incidence of major complications, in-hospital mortality, and unplanned ICU admission, ICU and in-hospital length of stay were comparable in both groups. CONCLUSIONS In conclusion, among adult patients undergoing elective lung resection, an OLV with lower tidal volume, PEEP 5 cmH2O, and ARMs and a higher tidal volume strategy resulted in low ARDS incidence and comparable postoperative complications, in-hospital length of stay, and mortality.
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Affiliation(s)
- Federico Piccioni
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Nicola Langiano
- SOC Anesthesia and Intensive Care Medicine Clinic - Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Guarnieri
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Paolo Proto
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Rocco D'Andrea
- Department of Anesthesia, Intensive Care Medicine and Emergency, IRRCS Policlinico di Sant' Orsola, Bologna Academic Hospital, Bologna, Italy
| | - Carlo A Mazzoli
- Department of Anesthesia, Intensive Care Medicine and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Ilaria Riccardi
- SOC Anesthesia and Intensive Care Medicine Clinic - Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Luca Guzzetti
- ASST Settelaghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Irene Rossi
- Cardio-thoracic and vascular Department, UOC Cardio-thoracic and vascular Anesthesia and ICM, Azienda ospedaliero-universitaria Senese, Siena, Italy
| | - Sabino Scolletta
- Cardio-thoracic and vascular Department, UOC Cardio-thoracic and vascular Anesthesia and ICM, Azienda ospedaliero-universitaria Senese, Siena, Italy
| | - Daniela Comi
- Anesthesia and Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alberto Benigni
- Anesthesia and Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Pierconti
- IRCCS-IFO National Institute of Oncology - Regina Elena, DPT of Oncologic Clinic and Research, UOC Anesthesia and ICM, Rome, Italy
| | - Cecilia Coccia
- IRCCS-IFO National Institute of Oncology - Regina Elena, DPT of Oncologic Clinic and Research, UOC Anesthesia and ICM, Rome, Italy
| | - Matteo Biscari
- Arcispedale Santa Maria Nuova, IRCCS AUSL di Reggio Emilia, Italy
| | - Alice Murzilli
- Arcispedale Santa Maria Nuova, IRCCS AUSL di Reggio Emilia, Italy
| | - Marzia Umari
- SOC Anesthesia and Intensive Care Medicine - Azienda Sanitaria Universitaria Giuliana, Cattinara Hospital, Trieste, Italy
| | - Caterina Peratoner
- SOC Anesthesia and Intensive Care Medicine - Azienda Sanitaria Universitaria Giuliana, Cattinara Hospital, Trieste, Italy
| | - Eugenio Serra
- Anesthesia and Intensive Care Medicine Institute - Azienda Ospedaliera-Università of Padua, Padua, Italy
| | | | - Rosanna Accardo
- Division of Anesthesia, Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori Fondazione G. Pascale - IRCCS, Naples, Italy
| | - Fernanda Diana
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Brotzu - Ospedale Oncologico Businco, Cagliari, Italy
| | | | - Riccardo Amodio
- Department of Anesthesia, Intensive Care and Pain Medicine, IRCCS Centro di Riferimento Oncologico della Basilicata/OECI Clinical Cancer Center - Rionero in Vulture, Potenza, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
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10
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Yao F, Wu W, Zhu Q, Zhu Y, Xu X, Chen L. Difficulty of Video-Assisted Thoracoscopic Surgery Segmentectomy: Proposal for a New Classification. Ann Surg Oncol 2023; 30:6707-6716. [PMID: 37306850 DOI: 10.1245/s10434-023-13702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Segmentectomy has classically been distinguished as "simple" or "complex" based on the number of intersegmental planes (ISPs) dissected. However, with the increasing variety and complexity of segmentectomies, it is clear that a classification based on the number of ISPs alone is inadequate. This study aimed to develop a new classification to predict the surgical difficulty of video-assisted thoracoscopic surgery (VATS) segmentectomy. METHODS The study retrospectively reviewed 1868 patients who underwent VATS segmentectomy between January 2014 and December 2019. Uni- and multivariate analyses were performed to identify predictors associated with prolonged operative time (>140 min), and a scoring system was constructed to classify the surgical difficulty of VATS segmentectomy. RESULTS Altogether, 1868 VATS segmentectomies were divided into three groups: group 1 (low difficulty, including segmentectomy with only one intersegmental plane [ISP] dissection), group 2 (intermediate difficulty, including a single segmentectomy with more than one ISP dissection and a single subsegmentectomy), group 3 (high difficulty level, including combined resection with more than one ISP dissection). This classification effectively differentiated the three groups in terms of operative time, estimated blood loss, major complications, and overall complications (all p < 0.001). For receiver operating characteristic analysis, the new classification showed significantly better differentiation performance in terms of operative time (p < 0.001), estimated blood loss (p = 0.004), major complications (p = 0.002), and overall complications (p = 0.012) than the simple/complex classification. CONCLUSIONS This new three-level classification accurately predicted the surgical difficulty of VATS segmentectomy.
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Affiliation(s)
- Fei Yao
- Department I of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Weibing Wu
- Department I of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Quan Zhu
- Department I of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yining Zhu
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinfeng Xu
- Department I of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Liang Chen
- Department I of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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11
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Soilly AL, Aho Glélé LS, Bernard A, Abou Hanna H, Filaire M, Magdaleinat P, Marty-Ané C, Tronc F, Grima R, Baste JM, Thomas PA, Richard De Latour B, Pforr A, Pagès PB. Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01). BMC Health Serv Res 2023; 23:1004. [PMID: 37723516 PMCID: PMC10507914 DOI: 10.1186/s12913-023-09962-y] [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] [Received: 06/20/2022] [Accepted: 08/24/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Lungsco01 is the first study assessing the real benefits and the medico-economic impact of video-thoracoscopy versus open thoracotomy for non-small cell lung cancer in the French context. METHODS Two hundred and fifty nine adult patients from 10 French centres were randomised in this prospective multicentre randomised controlled trial, between July 29, 2016, and November 24, 2020. Survival from surgical intervention to day 30 and later was compared with the log-rank test. Total quality-adjusted-life-years (QALYs) were calculated using the EQ-5D-3L®. For medico-economic analyses at 30 days and at 3 months after surgery, resources consumed were valorised (€ 2018) from a hospital perspective. First, since mortality was infrequent and not different between the two arms, cost-minimisation analyses were performed considering only the cost differential. Second, based on complete cases on QALYs, cost-utility analyses were performed taking into account cost and QALY differential. Acceptability curves and the 95% confidence intervals for the incremental ratios were then obtained using the non-parametric bootstrap method (10,000 replications). Sensitivity analyses were performed using multiple imputations with the chained equation method. RESULTS The average cumulative costs of thoracotomy were lower than those of video-thoracoscopy at 30 days (€9,730 (SD = 3,597) vs. €11,290 (SD = 4,729)) and at 3 months (€9,863 (SD = 3,508) vs. €11,912 (SD = 5,159)). In the cost-utility analyses, the incremental cost-utility ratio was €19,162 per additional QALY gained at 30 days (€36,733 at 3 months). The acceptability curve revealed a 64% probability of efficiency at 30 days for video-thoracoscopy, at a widely-accepted willingness-to-pay threshold of €25,000 (34% at 3 months). Ratios increased after multiple imputations, implying a higher cost for video-thoracoscopy for an additional QALY gain (ratios: €26,015 at 30 days, €42,779 at 3 months). CONCLUSIONS Given our results, the economic efficiency of video-thoracoscopy at 30 days remains fragile at a willingness-to-pay threshold of €25,000/QALY. The economic efficiency is not established beyond that time horizon. The acceptability curves given will allow decision-makers to judge the probability of efficiency of this technology at other willingness-to-pay thresholds. TRIAL REGISTRATION NCT02502318.
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Affiliation(s)
- Anne-Laure Soilly
- Direction of Clinical Research and Innovation, Clinical Research Unit-Methodological Support Network, CHU Dijon-Bourgogne, 21000, Dijon, France.
| | | | - Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
| | - Halim Abou Hanna
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
| | - Marc Filaire
- Department of Thoracic Surgery and Endocrine Surgery, Centre Jean Perrin, Clermont Auvergne University, Clermont-Ferrand, France
| | | | - Charles Marty-Ané
- Department of Thoracic and Cardiovascular Surgery, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France
| | - François Tronc
- Department of Thoracic Surgery, HCL, Hôpital Louis Pradel, Bron, France
| | - Renaud Grima
- Department of Thoracic Surgery, HCL, Hôpital Louis Pradel, Bron, France
| | | | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, North University Hospital, Aix-Marseille University & APHM, Marseille, France
| | | | - Arnaud Pforr
- Department of Thoracic and Vascular Surgery, Avignon, Avignon, CH, France
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12
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Hadaya J, Verma A, Marzban M, Sanaiha Y, Shemin RJ, Benharash P. Impact of Pulmonary Complications on Outcomes and Resource Use After Elective Cardiac Surgery. Ann Surg 2023; 278:e661-e666. [PMID: 36538628 DOI: 10.1097/sla.0000000000005750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To characterize the impact of pulmonary complications (PCs) on mortality, costs, and readmissions after elective cardiac operations in a national cohort and to test for hospital-level variation in PC. BACKGROUND PC after cardiac surgery are targets for quality improvement efforts. Contemporary studies evaluating the impact of PC on outcomes are lacking, as is data regarding hospital-level variation in the incidence of PC. METHODS Adults undergoing elective coronary artery bypass grafting and/or valve operations were identified in the 2016-2019 Nationwide Readmissions Database. PC was defined as a composite of reintubation, prolonged (>24 hours) ventilation, tracheostomy, or pneumonia. Generalized linear models were fit to evaluate associations between PC and outcomes. Institutional variation in PC was studied using observed-to-expected ratios. RESULTS Of 588,480 patients meeting study criteria, 6.7% developed PC. After risk adjustment, PC was associated with increased odds of mortality (14.6, 95% CI, 12.6-14.8), as well as a 7.9-day (95% CI, 7.6-8.2) increase in length of stay and $41,300 (95% CI, 39,600-42,900) in attributable costs. PC was associated with 1.3-fold greater hazard of readmission and greater incident mortality at readmission (6.7% vs 1.9%, P <0.001). Significant hospital-level variation in PC was present, with observed-to-expected ratios ranging from 0.1 to 7.7. CONCLUSIONS Pulmonary complications remain common after cardiac surgery and are associated with substantially increased mortality and expenditures. Significant hospital-level variation in PC exists in the United States, suggesting the need for systematic quality improvement efforts to reduce PC and their impact on outcomes.
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Affiliation(s)
- Joseph Hadaya
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA
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13
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Chang PC, Chen PH, Chang TH, Chen KH, Jhou HJ, Chou SH, Chang TW. Incentive spirometry is an effective strategy to improve the quality of postoperative care in patients. Asian J Surg 2023; 46:3397-3404. [PMID: 36437210 DOI: 10.1016/j.asjsur.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/15/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
Postoperative pulmonary complications (PPCs) most commonly occur after thoracic surgery. Not only prolonged hospital stay and increased financial expenses but also morbidity and even mortality may be troublesome for those with PPCs. Herein, we aimed to conduct a comprehensive systematic review and meta-analysis of available data to examine the effectiveness of incentive spirometry (IS) to reduce PPCs and shorten hospital stay. This systematic review and meta-analysis included 5 randomized controlled trials (RCT) and 3 retrospective cohort study (10,322 patients in total) in PubMed, Embase and Cochrane Library until September 31, 2021. We assessed the clinical efficacy of IS using length of hospital stay, PPCs, postoperative pneumonia, and postoperative atelectasis with meta-analysis, meta-regression and trial sequential analysis (TSA). With this meta-analysis, the length of hospital stay in patients undergoing IS was significantly shorter (1.8 days) than that in patients not receiving IS (MD = -1.80, 95% CI = -2.95 to -0.65). Patients undergoing IS also had reduced risk of PPCs (32%) and postoperative pneumonia (17.9%) with statistical significance than patients not undergoing IS (PPC: OR = 0.68, 95% CI = 0.51-0.90) (Pneumonia: OR = 0.821, 95% CI = 0.677-0.995).In meta-regression, the benefits of undergoing IS in patients with preoperative predicted FEV1 of <80% in a linear fashion with decreasing PPCs. IS is an effective modality to improve the quality of postoperative care for patients after pulmonary resection, compared with the control group without using IS; and applying IS has favorable outcomes of shorter length of hospital stay (1.8 days) and lower occurrence of PPCs (32% of risk reduction), which are conclusive and robust based on our validation via TSA. Moreover, the IS device is more beneficial for patients with preoperative predicted FEV1 of <80% than that in others.
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Affiliation(s)
- Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Ph. D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Ting-Hsuan Chang
- School of Medicine, China Medical University, Taichung City, Taiwan
| | - Kai-Hua Chen
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ting-Wei Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.
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14
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Bashour SI, Ost DE. An update on bronchopleural fistulae following cancer-related surgery. Curr Opin Pulm Med 2023; 29:223-231. [PMID: 37102602 DOI: 10.1097/mcp.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE OF REVIEW Bronchopleural fistulae (BPF) are rare complications in cancer-related surgery but impart significant morbidity and mortality. BPF may be difficult to identify, with a broad differential diagnosis at presentation, so it is critical to be aware of newer diagnostic and therapeutic approaches for this disease entity. RECENT FINDINGS Multiple novel diagnostic and therapeutic interventions are featured in this review. Reports of newer bronchoscopic techniques to localize BPF, as well as approaches for bronchoscopic management, like stent deployment, endobronchial valve placement, or alternative interventions when indicated are discussed, paying particular attention to factors that influence procedure selection. SUMMARY Management of BPF remains highly variable, but several novel approaches have shown improved identification and outcomes. Although a multidisciplinary approach is imperative, an understanding of these newer techniques is important to provide optimal care for patients.
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Affiliation(s)
- Sami I Bashour
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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15
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Hu D, Liu B, Li X, Chen H, Guo R, Cheng L, Lu X, Wu N. A Hierarchy-driven Multi-label Network with Label Constraints for Post-operative Complication Prediction of Lung Cancer . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38083421 DOI: 10.1109/embc40787.2023.10339943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Lung cancer is one of the most dangerous cancers all over the world. Surgical resection remains the only potentially curative option for patients with lung cancer. However, this invasive treatment often causes various complications, which seriously endanger patient health. In this study, we proposed a novel multi-label network, namely a hierarchy-driven multi-label network with label constraints (HDMN-LC), to predict the risk of complications of lung cancer patients. In this method, we first divided all complications into pulmonary and cardiovascular complication groups and employed the hierarchical cluster algorithm to analyze the hierarchies between these complications. After that, we employed the hierarchies to drive the network architecture design so that related complications could share more hidden features. And then, we combined all complications and employed an auxiliary task to predict whether any complications would occur to impose the bottom layer to learn general features. Finally, we proposed a regularization term to constrain the relationship between specific and combined complication labels to improve performance. We conducted extensive experiments on real clinical data of 593 patients. Experimental results indicate that the proposed method outperforms the single-label, multi-label baseline methods, with an average AUC value of 0.653. And the results also prove the effectiveness of hierarchy-driven network architecture and label constraints. We conclude that the proposed method can predict complications for lung cancer patients more effectively than the baseline methods.Clinical relevance-This study presents a novel multi-label network that can more accurately predict the risk of specific postoperative complications for lung cancer patients. The method can help clinicians identify high-risk patients more accurately and timely so that interventions can be implemented in advance to ensure patient safety.
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16
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Brat K, Chovanec Z, Mitas L, Sramek V, Olson LJ, Cundrle I. Hyperoxemia post thoracic surgery - Does it matter? Heliyon 2023; 9:e17606. [PMID: 37416669 PMCID: PMC10320252 DOI: 10.1016/j.heliyon.2023.e17606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Post-operative oxygen therapy is used to prevent hypoxemia and surgical site infection. However, with improvements of anesthesia techniques, post-operative hypoxemia incidence is declining and the benefits of oxygen on surgical site infection have been questioned. Moreover, hyperoxemia might have adverse effects on the pulmonary and cardiovascular systems. We hypothesized hyperoxemia post thoracic surgery is associated with post-operative pulmonary and cardiovascular complications. Methods Consecutive lung resection patients were included in this post-hoc analysis. Post-operative pulmonary and cardiovascular complications were prospectively assessed during the first 30 post-operative days, or hospital stay. Arterial blood gases were analyzed at 1, 6 and 12 h after surgery. Hyperoxemia was defined as arterial partial pressure of oxygen (PaO2)>100 mmHg. Patients with hyperoxemia duration in at least two adjacent time points were considered as hyperoxemic. Student t-test, Mann-Whitney U test and two-tailed Fisher exact test were used for group comparison. P values < 0.05 were considered statistically significant. Results Three hundred sixty-three consecutive patients were included in this post-hoc analysis. Two hundred five patients (57%), were considered hyperoxemic and included in the hyperoxemia group. Patients in the hyperoxemia group had significantly higher PaO2 at 1, 6 and 12 h after surgery (p < 0.05). Otherwise, there was no significant difference in age, sex, comorbidities, pulmonary function tests parameters, lung surgery procedure, incidence of post-operative pulmonary and cardiovascular complications, intensive care unit and hospital length of stay and 30-day mortality. Conclusion Hyperoxemia after lung resection surgery is common and not associated with post-operative complications or 30-day mortality.
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Affiliation(s)
- Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Zdenek Chovanec
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- First Department of Surgery, St. Anne's University Hospital, Brno, Czech Republic
| | - Ladislav Mitas
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Surgery, University Hospital Brno, Czech Republic
| | - Vladimir Sramek
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Anesthesiology and Intensive Care, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Lyle J. Olson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Ivan Cundrle
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Anesthesiology and Intensive Care, St. Anne's University Hospital Brno, Brno, Czech Republic
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Semmelmann A, Baar W, Haude H, Moneke I, Loop T. Risk Factors for Postoperative Pulmonary Complications Leading to Increased Morbidity and Mortality in Patients Undergoing Thoracic Surgery for Pleural Empyema. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00252-5. [PMID: 37236839 DOI: 10.1053/j.jvca.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Surgery for pleural empyema carries a high burden of morbidity and mortality. The authors investigated the incidence of postoperative pulmonary complications (PPCs) and their effects on perioperative morbidity and mortality. Patient-specific, preoperative, procedural, and postoperative risk factors for PPCs were analyzed. DESIGN Retrospective observational study. SETTING A single, large university hospital. PARTICIPANTS A total of 250 adult patients were included who underwent thoracic surgery for pleural empyema between January 2017 and December 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 250 patients with pleural empyema underwent thoracic surgery by video-assisted thoracoscopic surgery (49%; n = 122) or open thoracotomy (51%; n = 128). A proportion (42% [105]) of patients had ≥1 PPCs; 28% (n = 70) had to undergo resurgery; and 10% (n = 25) were re-admitted unexpectedly to the ICU. Preoperative respiratory failure (odds ratio [OR]: 5.8, 95% CI: 2.4-13.1), general anesthesia without regional analgesia techniques (OR: 2.9, 95% CI: 1.4-5.8), open thoracotomy and subsequent resurgery (OR: 3.9, 95% CI 1.5-9.9), surgery outside the regular working hours (OR: 3.1, 95% CI 1.2-8.2), and postoperative sepsis (OR: 2.6, 95% CI 1.1-6.8) were identified as independent risk factors for PPCs. Postoperative pulmonary complications were independent factors for unplanned intensive care unit admission (OR: 10.5, 95% CI 2.1-51 for >1 PPC), death within 360 days (OR: 4.5, 95% CI 2.2-12.3 for ≥2 PPCs), and death within 30 days for ≥1 PPCs (OR: 1.2, 95% CI 1.1-1.3). CONCLUSIONS The incidence of PPCs is a significant risk factor for morbidity and mortality after surgery for pleural empyema. Targeting the risk factors identified in this study could improve patient outcomes.
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Affiliation(s)
- Axel Semmelmann
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Wolfgang Baar
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Haron Haude
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Isabelle Moneke
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Torsten Loop
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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18
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Dogruyol T, Kahraman S, Dogruyol S, Buz M, Cimenoglu B, Ozdemir A, Dogu Geyik F, Demirhan R. Is intensive care necessary after major thoracic surgery? A propensity score-matched study. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:229-238. [PMID: 37484638 PMCID: PMC10357857 DOI: 10.5606/tgkdc.dergisi.2023.23501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/20/2022] [Indexed: 07/25/2023]
Abstract
Background This study aims to compare the surgical results, complications, mortality rates, and inpatient costs in two patient groups followed, whether in the intensive care unit or general ward after a major thoracic procedure and to examine clinical and surgical factors related to the development of complications. Methods Between January 2018 and June 2021, a total of 485 patients (150 males, 335 females; mean age: 58.3±13.2 years; range, 22 to 86 years) who underwent a major thoracic surgery in our clinic were retrospectively analyzed. The patients were divided into two groups as the intensive care unit patients (n=254) and general ward patients (n=231). In the former group, the patients were followed in the intensive care unit for a day, while in the general ward group, the patients were taken directly to the ward. The groups were compared after propensity score matching. All patients were analyzed for risk factors of morbidity development. Results After propensity score matching, 246 patients were enrolled including 123 patients in each group. There was no statistically significant difference between the groups in any features except for late morbidity, and inpatient costs were higher in the intensive care unit group (p<0.05). In the multivariate analysis, age, American Society of Anesthesiologists Class 3, and secondary malignancy were found to be associated with morbidity (p<0.05). Conclusion In experienced centers, it is both safe and costeffective to follow almost all of the major thoracic surgery patients postoperatively in the general ward.
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Affiliation(s)
- Talha Dogruyol
- Department of Thoracic Surgery, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye
| | - Selime Kahraman
- Department of Thoracic Surgery, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye
| | - Sinem Dogruyol
- Emergency Medicine, Haydarpaşa Numune Training and Research Hospital, Istanbul, Türkiye
| | - Mesut Buz
- Department of Thoracic Surgery, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye
| | - Berk Cimenoglu
- Department of Thoracic Surgery, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye
| | - Attila Ozdemir
- Department of Thoracic Surgery, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye
| | - Fatih Dogu Geyik
- Department of Anesthesiology and Reanimation, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye
| | - Recep Demirhan
- Department of Thoracic Surgery, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye
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19
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Brovman EY, Zorrilla-Vaca A, Urman RD. Regional Anesthesia for Lobectomy and Risk of Pulmonary Complications: A National Safety Quality Improvement Program Propensity-Matching Analysis. J Cardiothorac Vasc Anesth 2023; 37:547-554. [PMID: 36609074 DOI: 10.1053/j.jvca.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether general anesthesia (GA) in conjunction with regional anesthetic (RA) techniques are associated with favorable pulmonary outcomes versus GA alone among patients undergoing lobectomy by either video-assisted thoracoscopic surgery (VATS) or open thoracotomy. DESIGN A retrospective cohort (2014-2017). SETTING The American College of Surgeons National Surgical Quality Improvement Program. PARTICIPANTS Adult patients undergoing lobectomy by either VATS or open thoracotomy. INTERVENTIONS Two groups of patients were identified based on the use of GA alone or GA in conjunction with RA (RA+GA) techniques (either neuraxial or peripheral nerve blocks). Both groups were propensity-matched based on pulmonary risk factors. The authors' primary outcome was composite postoperative pulmonary complication (PPC), including pneumonia, reintubation, and failure to wean from the ventilator. MEASUREMENTS AND MAIN RESULTS A total of 4,134 VATS (2,067 in GA and 2,067 in RA+GA) and 3,112 thoracotomies (1,556 in GA and 1,556 in RA+GA) were included in the final analysis. Regional anesthetic, as an adjuvant to GA, did not affect the incidence of PPC among patients undergoing lobectomy by VATS (odds ratio [OR] 1.07, 95% CI 0.81-1.43, p = 0.622), as well as in those undergoing lobectomy via thoracotomy (OR 1.19, 95% CI 0.93-1.51, p = 0.174). There was no statistically significant difference between groups in terms of readmission rates, length of stay, and mortality at 30 days. CONCLUSIONS The RA techniques were not associated with a lower incidence of pulmonary complications in lobectomy surgery.
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Affiliation(s)
- Ethan Y Brovman
- Department of Anesthesiology, and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Andres Zorrilla-Vaca
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA
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20
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Serce Unat D, Ulusan Bagci O, Unat OS, Kose S, Caner A. The Spectrum of Infections in Patients with Lung Cancer. Cancer Invest 2023; 41:25-42. [PMID: 36445108 DOI: 10.1080/07357907.2022.2153860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Although diagnostic and therapeutic advances in lung cancer (LC) have increased the survival of patients, infection and its complications are still among the most important causes of mortality. The disruption of tissue caused by tumor mass, management of cancer therapy and alteration in the humoral/cellular immune systems due to both cancer itself and therapy considerably increase susceptibility to infection in cancer patients. Particularly, opportunistic microorganisms should be considered, then applying rapid and sensitive diagnostic methods for them. Thus, cancer patients who are already exposed to difficult, long-term and expensive treatments can be prevented from dying from complications related to infections.
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Affiliation(s)
- Damla Serce Unat
- Department of Chest Disease, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ozlem Ulusan Bagci
- Department of Microbiology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.,Department of Basic Oncology, Institute of Health Sciences, Ege University, Izmir, Turkey
| | - Omer Selim Unat
- Department of Chest Disease, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ayse Caner
- Department of Basic Oncology, Institute of Health Sciences, Ege University, Izmir, Turkey.,Translational Pulmonary Research Group (EGESAM), Ege University, Izmir, Turkey.,Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey.,Cancer Research Center, Ege University, Izmir, Turkey
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21
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Advantages of applying digital chest drainage system for postoperative management of patients following pulmonary resection: a systematic review and meta-analysis of 12 randomized controlled trials. Gan To Kagaku Ryoho 2023; 71:1-11. [PMID: 36175611 DOI: 10.1007/s11748-022-01875-7] [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: 07/19/2022] [Accepted: 09/20/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This meta-analysis aimed to evaluate the value of the chest digital drainage system for the postoperative management of patients who have undergone pulmonary resection. METHODS We searched the PubMed, EMBASE, the Cochrane Library, and Web of Science databases for included randomized controlled trials (RCTs) on the application of digital drainage systems versus the analog drainage system for patients with lung disease after pulmonary resection. Dichotomous variables were evaluated using risk ratios (RRs) and 95% confidence intervals (CIs), and mean and standardized mean differences (MDs and SMDs, respectively) with 95% CIs were used to calculate continuous variables. Statistical analyses were performed using Stata and RevMan software. RESULTS In total, 12 RCTs involving 2000 patients were analyzed. Significant differences in duration of chest tube placement (SMD = -0.49; 95% CI = -0.78 to -0.20), length of hospital stay (MD =-0.79 days; 95% CI = -1.24 to -0.34), and number of chest tube clamping tests (RR = 0.74; 95% CI = 0.36-1.49) were observed between the two groups, which did not significant differ in the occurrence of prolonged air leak or cardiopulmonary complication rate. CONCLUSIONS The digital chest drainage system is mainly advantageous in the duration of chest tube placement, length of hospital stay, and number of chest tube clamping tests. Future research should evaluate the requirements and economic impact of using digital system in routine clinical practice.
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22
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Isaka T, Ito H, Yokose T, Saito H, Adachi H, Miura J, Murakami K, Rino Y. Impact of segmentectomy and lobectomy on non-lung cancer death in early-stage lung cancer patients. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6705233. [PMID: 36124963 DOI: 10.1093/ejcts/ezac458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/23/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to analyse the risk of death from non-lung cancer after segmentectomy or lobectomy for early-stage lung cancer. METHODS A total of 1385 patients underwent lobectomy or segmentectomy for clinical stage 0-I primary lung cancer, with no evidence of recurrence after surgery, between January 2008 and December 2018. Risk factors for non-lung cancer deaths (NLCD) were analysed using multivariable logistic regression analysis. The overall survival (OS) of patients with low and high comorbidities who underwent lobectomy and segmentectomy was compared using a log-rank test. RESULTS Patients with NLCD (n = 126) were more likely to have undergone lobectomy than patients with non-recurrence survival (n = 1259). Multivariable analysis revealed that age (≥65 years), smoking index (≥600), body mass index (≤18.5 kg/m2), interstitial pneumonia, values for percentage of predicted vital capacity (≤9.4%) and lobectomy were risk factors for NLCD. Patients who underwent segmentectomy had significantly better 5-year OS than those who underwent lobectomy, after propensity score matching (94.6% vs 90.4%, P = 0.027). Patients with high comorbidities (patients with ≥2 of the following risks: age ≥65 years, smoking index ≥600, body mass index ≤18.5 kg/m2, Charlson Comorbidity Index ≥1, values for percentage of predicted vital capacity ≤96.4%) who underwent segmentectomy had a better 5-year OS than those who underwent lobectomy (92.8% vs 87.8%, P = 0.016). However, there was no difference in 5-year OS between segmentectomy and lobectomy in patients with low comorbidities (98.5% vs 97.4%, P = 0.867). CONCLUSIONS The impact of lobectomy and segmentectomy on NLCD depends on the extent of the patients' comorbidities.
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Affiliation(s)
- Tetsuya Isaka
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiro Saito
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroyuki Adachi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Jun Miura
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kotaro Murakami
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
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23
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Wang JY, Pang QY, Yang YJ, Feng YM, Xiang YY, An R, Liu HL. Development and Validation of a Nomogram for Predicting Postoperative Pulmonary Infection in Patients Undergoing Lung Surgery. J Cardiothorac Vasc Anesth 2022; 36:4393-4402. [PMID: 36155718 DOI: 10.1053/j.jvca.2022.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/12/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To develop and validate a nomogram for predicting postoperative pulmonary infection (PPI) in patients undergoing lung surgery. DESIGN Single-center retrospective cohort analysis. SETTING A university-affiliated cancer hospital PARTICIPANTS: A total of 1,501 adult patients who underwent lung surgery from January 2018 to December 2020. INTERVENTIONS Observation for PPI within 7 days after lung surgery. MEASUREMENTS AND MAIN RESULTS A complete set of demographics, preoperative variables, and postoperative follow-up data was recorded. The primary outcome was PPI; a total of 125 (8.3%) out of 1,501 patients developed PPI. The variables with p < 0.1 in univariate logistic regression were included in the multivariate regression, and multivariate logistic regression analysis showed that surgical procedure, surgical duration, the inspired fraction of oxygen in one-lung ventilation, and postoperative pain were independent risk factors for PPI. A nomogram based on these factors was constructed in the development cohort (area under the curve: 0.794, 95% CI 0.744-0.845) and validated in the validation cohort (area under the curve: 0.849, 95% CI 0.786-0.912). The calibration slope was 1 in the development and validation cohorts. Decision curve analysis indicated that when the threshold probability was within a range of 0.02-to-0.58 and 0.02-to-0.42 for the development and validation cohorts, respectively, the nomogram model could provide a clinical net benefit. CONCLUSIONS The authors developed and validated a nomogram for predicting PPI in patients undergoing lung surgery. The prediction model can predict the development of PPI and identify high-risk groups.
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Affiliation(s)
- Jing-Yun Wang
- School of Medicine, Chongqing University, Chongqing, China; Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Qian-Yun Pang
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Ya-Jun Yang
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Yu-Mei Feng
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Ying-Ying Xiang
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Ran An
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China
| | - Hong-Liang Liu
- Department of Anaesthesia, Chongqing University Cancer Hospital, Chongqing, China.
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24
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Pressure-dependent persistent air leak in a patient with secondary spontaneous pneumothorax. Am J Med Sci 2022; 364:782-788. [PMID: 35787363 DOI: 10.1016/j.amjms.2022.06.013] [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: 10/11/2021] [Revised: 04/03/2022] [Accepted: 06/27/2022] [Indexed: 01/25/2023]
Abstract
An air leak lasting more than 5-7 days (persistent air leak, PAL) can complicate up to 40% of patients with secondary spontaneous pneumothorax. Chronic obstructive pulmonary disease is the most common cause of secondary spontaneous pneumothorax, and early surgical intervention has been recommended for patients with PAL. Bullectomy or blebectomy with concomitant mechanical pleurodesis by medical thoracoscopy or video assisted thoracoscopic surgery is considered definitive therapy. Unfortunately, the perioperative course following lung resection can also be complicated by air leaks leading to worse clinical outcomes. Post lung resection air leak can be pressure independent or pressure dependent (also known as drainage-related air leak). The distinction between these two entities is crucial as the management varies drastically. Pleural manometry may play an important role in the early diagnosis of pressure-dependent PAL preventing further unnecessary surgical procedures from being performed.
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25
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Ceylan KC, Batıhan G, Kaya ŞÖ. Novel method for bronchial stump coverage for prevents postpneumonectomy bronchopleural fistula: pedicled thymopericardial fat flap. J Cardiothorac Surg 2022; 17:286. [DOI: 10.1186/s13019-022-02032-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Bronchopleural fistula (BPF) is a serious complication with high mortality and morbidity that can be seen after lung resections. Although several methods have been described to prevent postoperative BPF it is still unclear which method is the best. In this study, we have used tymopericardial fat flap (TPFF) to cover the bronchial stump in patients after pneumonectomy and aim to show its feasibility and efficacy to prevent BPF.
Methods
Between January 2013 and June 2021, 187 patients with lung cancer underwent pneumonectomy at our institution. Among them, 53 patients underwent bronchial stump coverage with TPFF. In other 134 patients there wasn’t used any coverage method. Patient characteristics, preoperative status, surgical procedures, perioperative course, pathological findings, and long-term prognoses were evaluated retrospectively.
Results
Postoperative BPF was observed in 16 (%8.5) patients. It was observed that TPFF was applied in only 1 of the patients who developed BPF. A statistically significant difference was detected between TPFF-coverage with non-coverage groups in terms of postoperative BPF rates (p = 0.044). Other factors associated with the development of postoperative BPF in univariate analysis were right sided pneumonectomy, and re-operation.
Conclusion
Bronchial stump coverage with TPFF is a feasible and effective method to prevent postpneumonectomy BPF.
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26
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Kim SJ, Kang HR, Lee CG, Choi SH, Kim YW, Lee HW, Lee CH. Pulmonary sclerosing pneumocytoma and mortality risk. BMC Pulm Med 2022; 22:404. [DOI: 10.1186/s12890-022-02199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Surgical resection is usually recommended for the treatment of pulmonary sclerosing pneumocytoma (PSP). However, no comparative study has demonstrated that surgical resection leads to improved outcomes. We aimed to compare all-cause mortality between patients with PSP who underwent surgery or did not and those without PSP.
Methods
Participants aged ≥18 years who had pathologically diagnosed PSP between 2001 to 2018, at 3 hospitals were included. Randomly selected (up to 1:5) age-, sex-, and smoking status-matched controls without PSP who were randomly selected from those who underwent health checkups including chest CT were included. Mortality was compared using Kaplan–Meier estimates and Cox proportional hazards regression models. Literature review of studies reporting PSP was also conducted.
Results
This study included 107 patients with PSP (surgery:non-surgery, 80:27) and 520 matched controls. There were no cases of lymph node or distant metastasis, recurrence, or mortality from PSP. No significant difference in all-cause mortality risk was observed between the PSP surgery, PSP non-surgery, and non-PSP groups (log rank test P = 0.78) (PSP surgery vs. non-PSP: adjusted hazards ratio [aHR], 1.80; 95% confidence interval [CI], 0.22–14.6; PSP non-surgery vs. non-PSP: aHR, 0.77; 95% CI, 0.15–3.86; PSP surgery vs. PSP non-surgery: aHR, 2.35; 95% CI, 0.20–28.2). In the literature review, we identified 3469 patients with PSP from 355 studies. Only 1.33% of these patients reported metastasis, recurrence, or death.
Conclusions
All-cause mortality did not differ between patients with PSP and those without, irrespective of undergoing surgery. Our study and the literature review suggest that PSP has less impact on increased mortality risk.
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27
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Hata A, Hino T, Yanagawa M, Nishino M, Hida T, Hunninghake GM, Tomiyama N, Christiani DC, Hatabu H. Interstitial Lung Abnormalities at CT: Subtypes, Clinical Significance, and Associations with Lung Cancer. Radiographics 2022; 42:1925-1939. [PMID: 36083805 PMCID: PMC9630713 DOI: 10.1148/rg.220073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022]
Abstract
Interstitial lung abnormality (ILA) is defined as an interstitial change detected incidentally on CT images. It is seen in 4%-9% of smokers and 2%-7% of nonsmokers. ILA has a tendency to progress with time and is associated with respiratory symptoms, decreased exercise capability, reduced pulmonary function, and increased mortality. ILAs can be classified into three subcategories: nonsubpleural, subpleural nonfibrotic, and subpleural fibrotic. In cases of ILA, clinically significant interstitial lung disease should be identified and requires clinically driven management by a pulmonologist. Risk factors for the progression of ILA include clinical elements (ie, inhalation exposures, medication use, radiation therapy, thoracic surgery, physiologic findings, and gas exchange findings) and radiologic elements (ie, basal and peripheral predominance and fibrotic findings). It is recommended that individuals with one or more clinical or radiologic risk factors for progression of ILA be actively monitored with pulmonary function testing and CT. To avoid overcalling ILA at CT, radiologists must recognize the imaging pitfalls, including centrilobular nodularity, dependent abnormality, suboptimal inspiration, osteophyte-related lesions, apical cap and pleuroparenchymal fibroelastosis-like lesions, aspiration, and infection. There is a close association between ILA and lung cancer, and many studies have reported an increased incidence of lung cancer, worse prognoses, and/or increased pulmonary complications in relation to cancer treatment in patients with ILA. ILA is considered to be an important comorbidity in patients with lung cancer. Accordingly, all radiologists involved with body CT must have sound knowledge of ILAs owing to the high prevalence and potential clinical significance of these anomalies. An overview of ILAs, including a literature review of the associations between ILAs and lung cancer, is presented. ©RSNA, 2022.
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Affiliation(s)
- Akinori Hata
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Takuya Hino
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Masahiro Yanagawa
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Mizuki Nishino
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Tomoyuki Hida
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Gary M. Hunninghake
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Noriyuki Tomiyama
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - David C. Christiani
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Hiroto Hatabu
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
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Petrella F, Rizzo S, Bertolaccini L, Casiraghi M, Girelli L, Lo Iacono G, Mazzella A, Spaggiari L. The “Balloon-Like” Sign: Differential Diagnosis between Postoperative Air Leak and Residual Pleural Space: Radiological Findings and Clinical Implications of the Young–Laplace Equation. Cancers (Basel) 2022; 14:cancers14143533. [PMID: 35884595 PMCID: PMC9317249 DOI: 10.3390/cancers14143533] [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: 06/13/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Postoperative residual pleural space and postoperative air leaks after lung resection are two different clinical entities requiring completely different approaches. Residual postoperative pleural space is a part of the pleural cavity that is not fully reoccupied by the remaining lung after pulmonary resection. No treatment is needed in the asymptomatic residual pleural space without any persistent air leak, and chest drain removal can be safely planned. On the contrary, an active and prolonged air leak after lung resection is an absolute contraindication to chest drain removal that may culminate in hypertensive pneumothorax, subcutaneous emphysema, and severe respiratory symptoms. In order to further contribute to an appropriate differential diagnosis between these two settings, we propose a radiological sign that is observed only in the case of residual plural space. In this case, in fact, the lung takes the form of a round balloon due to the hyperinflation condition, which is governed by the Young–Laplace equation describing the capillary pressure difference sustained across the interface between two static fluids, such as water and air, due to the phenomenon of wall tension. Abstract In this paper, we propose a radiological sign for an appropriate differential diagnosis between postoperative pleural space and active air leak after lung resection. In the case of residual pleural space without any active air leak, the lung takes the form of a round balloon due to the hyperinflation condition, which is governed by the Young–Laplace equation describing the capillary pressure difference sustained across the interface between two static fluids, such as water and air, due to the phenomenon of wall tension. The two principal mechanisms by which a lung forms a spherical image are shear-controlled detachment induced by shear stress on the membrane surface, and spontaneous detachment induced by a gradient in Young–Laplace pressure. On the contrary, the lung maintains its tapered shape in the case of an active air leak because the continuous air refill does not allow a complete parenchyma re-expansion.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (M.C.); (L.G.); (G.L.I.); (A.M.); (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20141 Milan, Italy
- Correspondence: or ; Tel.: +39-025-748-9362; Fax: +39-029-437-9218
| | - Stefania Rizzo
- Department of Radiology, Ente Ospedaliero Cantonale (EOC) Istituto di Imaging della Svizzera Italiana (IIMSI), 6903 Lugano, Switzerland;
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana, Via Buffi 13, 6900 Lugano, Switzerland
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (M.C.); (L.G.); (G.L.I.); (A.M.); (L.S.)
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (M.C.); (L.G.); (G.L.I.); (A.M.); (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20141 Milan, Italy
| | - Lara Girelli
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (M.C.); (L.G.); (G.L.I.); (A.M.); (L.S.)
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (M.C.); (L.G.); (G.L.I.); (A.M.); (L.S.)
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (M.C.); (L.G.); (G.L.I.); (A.M.); (L.S.)
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (M.C.); (L.G.); (G.L.I.); (A.M.); (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20141 Milan, Italy
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29
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Pezzuto A, Trabalza Marinucci B, Ricci A, Ciccozzi M, Tonini G, D'Ascanio M, Guerrieri G, Chianese M, Castelli S, Rendina EA. Predictors of respiratory failure after thoracic surgery: a retrospective cohort study with comparison between lobar and sub-lobar resection. J Int Med Res 2022; 50:3000605221094531. [PMID: 35768901 PMCID: PMC9251996 DOI: 10.1177/03000605221094531] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Only approximately 15% of patients with lung cancer are suitable for surgery and clinical postoperative outcomes vary. The aim of this study was to investigate variables associated with post-surgery respiratory failure in this patient cohort. Methods Patients who underwent surgery for lung cancer were retrospectively studied for respiratory function. All patients had undergone lung resection by a mini-thoracotomy approach. The study population was divided into two subgroups for comparison: lobectomy group, who underwent lobar resection; and sub-lobar resection group. Results A total of 85 patients were included, with a prevalence of lung cancer stage IA and adenocarcinoma histotype. Lobectomy (versus sub-lobar resection), the presence of chronic obstructive pulmonary disease (COPD), and a COPD assessment test (CAT) score >10, were all associated with an increased risk of respiratory failure. The partial pressure of arterial oxygen decreased more in the lobectomy group than in the sub-lobar resection group following surgery, with a significant postoperative between-group difference in values. Postoperative CAT scores were also better in the sub-lobar resection group. Conclusions Post-surgical variations in functional parameters were greater in the group treated by lobectomy. COPD, high CAT score and surgery type were associated with postoperative development of respiratory failure.
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Affiliation(s)
- Aldo Pezzuto
- Department of Cardiovascular and Respiratory Sciences, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | - Alberto Ricci
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Massimo Ciccozzi
- Department of Epidemiology, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Tonini
- Department of Oncology, Campus Bio-Medico University, Rome, Italy
| | - Michela D'Ascanio
- Department of Cardiovascular and Respiratory Sciences, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giulio Guerrieri
- Department of Cardiovascular and Respiratory Sciences, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Maria Chianese
- Department of Cardiovascular and Respiratory Sciences, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Silvia Castelli
- Department of Cardiovascular and Respiratory Sciences, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Erino Angelo Rendina
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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30
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Chang PC, Chen KH, Jhou HJ, Lee CH, Chou SH, Chen PH, Chang TW. Promising Effects of Digital Chest Tube Drainage System for Pulmonary Resection: A Systematic Review and Network Meta-Analysis. J Pers Med 2022; 12:jpm12040512. [PMID: 35455628 PMCID: PMC9029690 DOI: 10.3390/jpm12040512] [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: 02/26/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The chest tube drainage system (CTDS) of choice for the pleural cavity after pulmonary resection remains controversial. This systematic review and network meta-analysis (NMA) aimed to assess the length of hospital stay, chest tube placement duration, and prolonged air leak among different types of CTDS. Methods: This systemic review and NMA included 21 randomized controlled trials (3399 patients) in PubMed and Embase until 1 June 2021. We performed a frequentist random effect in our NMA, and a P-score was adopted to determine the best treatment. We assessed the clinical efficacy of different CTDSs (digital/suction/non-suction) using the length of hospital stay, chest tube placement duration, and presence of prolonged air leak. Results: Based on the NMA, digital CTDS was the most beneficial intervention for the length of hospital stay, being 1.4 days less than that of suction CTDS (mean difference (MD): −1.40; 95% confidence interval (CI): −2.20 to −0.60). Digital CTDS also had significantly reduced chest tube placement duration, being 0.68 days less than that of suction CTDSs (MD: −0.68; 95% CI: −1.32 to −0.04). Neither digital nor non-suction CTDS significantly reduced the risk of prolonged air leak. Conclusions: Digital CTDS is associated with better outcomes than suction and non-suction CTDS for patients undergoing pulmonary resections, specifically 0.68 days shorter chest tube duration and 1.4 days shorter hospital stay than suction CTDS.
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Affiliation(s)
- Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan; (P.-C.C.); (S.-H.C.)
- Weight Management Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
| | - Kai-Hua Chen
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan;
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua 50006, Taiwan;
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei City 11490, Taiwan;
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan; (P.-C.C.); (S.-H.C.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
- Correspondence: (P.-H.C.); (T.-W.C.); Tel.: +886-7-3121101 (ext. 6206)
| | - Ting-Wei Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan;
- Correspondence: (P.-H.C.); (T.-W.C.); Tel.: +886-7-3121101 (ext. 6206)
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31
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Liu A, Li M, Gao W, Wen X, Zhu H, Chen Y. Evaluating the impact of personalized rehabilitation nursing intervention on postoperative recovery of respiratory function among thoracic surgery patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28776. [PMID: 35244036 PMCID: PMC8896495 DOI: 10.1097/md.0000000000028776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Owing to clinical developments and economic strain, perioperative care has undergone considerable changes. Therefore, it is important to review and critique the efficacy of existing practices in a context that is placing increasing emphasis on better efficacy and cost-containment. Considering that the objective involves devising approaches to minimize postoperative complications and reduce medical care, efforts should concentrate on postsurgical pulmonary complications that are common. The present analysis aims to examine how customized rehabilitation nursing intercession impacts the postsurgical restoration of respiratory functions in thoracic surgery patients. METHODS Prespecified search strategies will be employed to perform a methodological search of 6 databases namely EMBASE, Cochrane Library, PubMed, Web of Science, WanFang Database, and China National Knowledge Infrastructure. The analysis will comprise original publications that evaluated how personalized rehabilitation nursing intervention impacts postsurgical restoration of respiratory function in those who have undergone thoracic surgery. All considered publications are before December 25, 2021. Different authors will conduct an independent study selection process to evaluate the quality of the publications and extract required data. Based on the standardized mean difference and its 95% confidence interval, we estimate the summary effects for each meta-analyses. Based on heterogeneity in considered articles, the related data will be pooled through either a random- or fixed-effect meta-analysis. Lastly, the overall quality of evidence using appropriate methods will be performed. RESULTS The results of this analysis will systematically evaluate how customized rehabilitation nursing interference impact postsurgical healing of respiratory functions in patients who have undergone thoracic surgery by collecting the existing evidence. ETHICS AND DISSEMINATION Not required. OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER 10.17605/OSF.IO/NBVYW.
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Affiliation(s)
- Ai Liu
- Department of Cardiothoracic Surgery, Wuhan Puren Hospital, Wuhan, Hubei Province, China
| | - Mian Li
- Department of Cardiothoracic Surgery, Wuhan Puren Hospital, Wuhan, Hubei Province, China
| | - Wenjin Gao
- Department of Neurosurgery, Wuhan Puren Hospital, Wuhan, Hubei Province, China
| | - Xiaoke Wen
- Department of Cardiothoracic Surgery, Wuhan Puren Hospital, Wuhan, Hubei Province, China
| | - Hui Zhu
- Outpatient Department, Wuhan Puren Hospital, Wuhan, Hubei Province, China
| | - Yanyan Chen
- Department of Cardiothoracic Surgery, Wuhan Puren Hospital, Wuhan, Hubei Province, China
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32
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Lee S, Cho JS, Kim E, Kim Y, Lee J. Effects of Inhalation versus Total Intravenous Anesthesia on Postoperative Pulmonary Complications after Anatomic Pulmonary Resection. J Chest Surg 2022; 55:30-36. [PMID: 35115419 PMCID: PMC8824648 DOI: 10.5090/jcs.21.119] [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: 09/29/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background No consensus exists regarding whether volatile anesthetics are superior to intravenous anesthetics for reducing postoperative pulmonary complications (PPCs) in patients undergoing general anesthesia for surgery. Studies of this issue focused on anatomic pulmonary resection are lacking. This study compared the effects of total intravenous anesthesia (TIVA) versus volatile anesthesia on PPCs after anatomic pulmonary resection in patients with lung cancer. Methods This retrospective study examined the medical records of patients with lung cancer who underwent lung resection at our center between January 2018 and October 2020. The primary outcome was the incidence of PPCs, which included prolonged air leak, pneumonia, acute respiratory distress syndrome, empyema, atelectasis requiring bronchofiberscopy (BFS), acute lung injury (ALI), bronchopleural fistula (BPF), pulmonary embolism, and pulmonary edema. Propensity score matching (PSM) was used to balance the 2 groups. In total, 579 anatomic pulmonary resection cases were included in the final analysis. Results The analysis showed no statistically significant difference between the volatile anesthesia and TIVA groups in terms of PPCs, except for prolonged air leak. Neither of the groups showed atelectasis requiring BFS, ALI, BPF, pulmonary embolism, or pulmonary edema after PSM. However, the length of hospitalization, intensive care unit stay, and duration of chest tube indwelling were shorter in the TIVA group. Conclusion Volatile anesthetics showed no superiority compared to TIVA in terms of PPCs after anatomical pulmonary resection in patients with lung cancer. Considering the advantages of each anesthetic modality, appropriate anesthetic modalities should be used in patients with different risk factors and situations.
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Affiliation(s)
- Soojin Lee
- Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Su Cho
- Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yeongdae Kim
- Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | - Jonggeun Lee
- Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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Fontana V, Coureau M, Grigoriu B, Tamburini N, Lemaitre J, Meert AP. [The role of the intensive care unit after thoracic surgery]. Rev Mal Respir 2022; 39:40-54. [PMID: 35034829 DOI: 10.1016/j.rmr.2021.12.006] [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: 06/11/2021] [Accepted: 12/08/2021] [Indexed: 12/24/2022]
Abstract
Lung (bronchial) cancer is the leading cause of cancer-related death in Western countries today. Thoracic surgery represents a major therapeutic strategy and the various advances made in recent years have made it possible to develop less and less invasive techniques. That said, the postoperative period may be lengthy, post-surgical approaches need to be more precisely codified, and it matters that the different interventions involved be supported by sound scientific evidence. To date, however, there exists no evidence that preventive postoperative admission to intensive care is beneficial for patients having undergone lung resection surgery without immediate complications. A stratification of the risk of complications taking into consideration the patient's general state of health (e.g., nutritional status, degree of autonomy, etc.), comorbidities and type of surgery could be a useful predictive tool regarding the need for postoperative intensive care. However, serious post-operative complications remain relatively frequent and post-operative management of these intensive care patients is liable to become complex and long-lasting. In the aftermath of the validation of "enhanced recovery after surgery" (ERAS) in thoracic surgery, new protocols are needed to optimize management of patients having undergone pulmonary resection. This article focuses on the main postoperative complications and more broadly on intensive care patient management following thoracic surgery.
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Affiliation(s)
- V Fontana
- Service de médecine interne, soins intensifs et urgences oncologiques, université Libre de Bruxelles (ULB), institut Jules-Bordet, rue Héger-Bordet, 1, 1000 Bruxelles, Belgique
| | - M Coureau
- Service de médecine interne, soins intensifs et urgences oncologiques, université Libre de Bruxelles (ULB), institut Jules-Bordet, rue Héger-Bordet, 1, 1000 Bruxelles, Belgique
| | - B Grigoriu
- Service de médecine interne, soins intensifs et urgences oncologiques, université Libre de Bruxelles (ULB), institut Jules-Bordet, rue Héger-Bordet, 1, 1000 Bruxelles, Belgique
| | - N Tamburini
- Département de morphologie, médecine expérimentale et chirurgie, section de chirurgie 1, hôpital Sant'Anna, université de Ferrara, Ferrara, Italie
| | - J Lemaitre
- Service de chirurgie thoracique, Ambroise Pare, Mons, Belgique
| | - A-P Meert
- Service de médecine interne, soins intensifs et urgences oncologiques, université Libre de Bruxelles (ULB), institut Jules-Bordet, rue Héger-Bordet, 1, 1000 Bruxelles, Belgique.
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Pulmonary Risk Assessment. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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35
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Yu Q, Yu H, Xu W, Pu Y, Nie Y, Dai W, Wei X, Wang XS, Cleeland CS, Li Q, Shi Q. Shortness of Breath on Day 1 After Surgery Alerting the Presence of Early Respiratory Complications After Surgery in Lung Cancer Patients. Patient Prefer Adherence 2022; 16:709-722. [PMID: 35340757 PMCID: PMC8943684 DOI: 10.2147/ppa.s348633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/04/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Patient-reported outcome (PRO)-based symptom assessment with a threshold can facilitate the early alert of adverse events. The purpose of this study was to determine whether shortness of breath (SOB) on postoperative day 1 (POD1) can inform postoperative pulmonary complications (PPCs) for patients after lung cancer (LC) surgery. METHODS Data were extracted from a prospective cohort study of patients with LC surgery. Symptoms were assessed by the MD Anderson Symptom Inventory-lung cancer module (MDASI-LC) before and daily after surgery. Types and grades of complications during hospitalization were recorded. SOB and other symptoms were tested for a possible association with PPCs by logistic regression models. Optimal cutpoints of SOB were derived, using the presence of PPCs as an anchor. RESULTS Among 401 patients with complete POD1 MDASI-LC and records on postoperative complications, 46 (11.5%) patients reported Clavien-Dindo grade II-IV PPCs. Logistic regression revealed that higher SOB score on POD1 (odds ratio [OR]=1.13, 95% CI=1.01-1.27), male (OR=2.86, 95% CI=1.32-6.23), open surgery (OR=3.03, 95% CI=1.49-6.14), and lower forced expiratory volume in one second (OR=1.78, 95% CI=1.66-2.96) were significantly associated with PPCs. The optimal cutpoint was 6 (on a 0-10 scale) for SOB. Patients reporting SOB < 6 on POD1 had shorter postoperative length of stay than those reporting 6 or greater SOB (median, 6 vs 7, P =0.007). CONCLUSION SOB on POD1 can inform the onset of PPCs in patients after lung cancer surgery. PRO-based symptom assessment with a clinically meaningful threshold could alert clinicians for the early management of PPCs.
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Affiliation(s)
- Qingsong Yu
- School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Hongfan Yu
- School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wei Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yang Pu
- School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yuxian Nie
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Qiuling Shi
- School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, People’s Republic of China
- Center for Cancer Prevention Research, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
- Correspondence: Qiuling Shi, School of Public Health and Management, Chongqing Medical University, No. 1, Medical School Road, Yuzhong District, Chongqing, 400016, People’s Republic of China, Tel +86-18290585397, Fax +86-28-85420116, Email
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Kim HE, Yu WS, Lee CY, Lee JG, Kim DJ, Park SY. Risk factors for pulmonary complications after neoadjuvant chemoradiotherapy followed by surgery for non-small cell lung cancer. Thorac Cancer 2021; 13:361-368. [PMID: 34905807 PMCID: PMC8807251 DOI: 10.1111/1759-7714.14263] [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: 09/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background We aimed to investigate the characteristics and pretreatment risk factors for postoperative pulmonary complications (PPCs) after neoadjuvant concurrent chemoradiotherapy (CRTx) in patients with non‐small cell lung cancer (NSCLC). Methods We retrospectively reviewed data of 122 patients who underwent curative resection after neoadjuvant CRTx for NSCLC between 2007 and December 2019. Clinical data, including pulmonary function and body mass index (BMI) at the time of concurrent CRTx initiation, were analyzed. We performed logistic regression analyses to identify the risk factors for PPCs and built a nomogram with significant factors. Results Of the 122 patients included (mean age, 60.1 ± 9.7 years; 69.7% male), 27 experienced PPCs (severity grade ≥ 2). The most common PPCs were pneumonia (n = 17). Patients with PPCs had a significantly longer hospital stay (median 6.0 vs. 17 days, p < 0.001) and a higher in‐hospital mortality rate (1.1% vs. 29.6%, p < 0.001). In multivariable analysis, lower BMI (odds ratio [OR] 0.796, 95% confidence interval [CI] 0.628–0.987, p = 0.038), no comorbidity (OR 0.220, 95% CI: 0.059–0.819, p = 0.048), smoking history (OR 4.362, 95% CI: 1.210–15.720, p = 0.024), and %predicted DLCO <60% (OR 3.727, 95% CI: 1.319–10.530, p = 0.013) were independent risk factors for PPCs. The predictive accuracy of the nomogram built with factors was excellent (concordance index: 0.756). Conclusions The nomogram constructed with factors identified in multivariable analysis could serve as a reliable tool for evaluating the risk of PPCs in the patients who underwent neoadjuvant CRTx for NSCLC.
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Affiliation(s)
- Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Sik Yu
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Chang S, Zhou K, Wang Y, Lai Y, Che G. Prognostic Value of Preoperative Peak Expiratory Flow to Predict Postoperative Pulmonary Complications in Surgical Lung Cancer Patients. Front Oncol 2021; 11:782774. [PMID: 34881188 PMCID: PMC8645567 DOI: 10.3389/fonc.2021.782774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives Cough impairment may lead to excessive accumulation of pulmonary secretions and increase the risk of postoperative pulmonary complications (PPCs). Peak expiratory flow (PEF) is a sensitive indicator of cough ability. We aimed to investigate the correlation between PEF and PPCs for lung cancer patients undergoing lobectomy or segmental resection for improved risk assessment. Methods This retrospective study assessed 560 patients with non-small cell lung cancer admitted for surgery between January 2014 to June 2016. The measurements of PEF were performed before surgery and the clinical outcomes were recorded, including PPCs, postoperative hospital stay, hospitalization costs, and other variables. Results Preoperative PEF was significantly lower in PPCs group compared to non-PPCs group (294.2 ± 95.7 vs. 363.0 ± 105.6 L/min, P < 0.001). Multivariable regression analysis showed that high PEF (OR=0.991, 95%CI: 0.988-0.993, P < 0.001) was an independent protective factor for PPCs. According to the receiver operating characteristic (ROC) curve, a PEF value of 250 L/min was selected as the optimal cutoff value in female patients, and 320 L/min in male patients. Patients with PEF under cutoff value of either sex had higher PPCs rate and unfavorable clinical outcomes. Conclusions Preoperative PEF was found to be a significant predictor of PPCs for surgical lung cancer patients. It may be beneficial to consider the cutoff value of PEF in perioperative risk assessment.
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Affiliation(s)
- Shuai Chang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Wang B, Chen Z, Zhao R, Zhang L, Zhang Y. Development and validation of a nomogram to predict postoperative pulmonary complications following thoracoscopic surgery. PeerJ 2021; 9:e12366. [PMID: 34760381 PMCID: PMC8572520 DOI: 10.7717/peerj.12366] [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: 03/08/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Postoperative pulmonary complications (PPCs) after thoracoscopic surgery are common. This retrospective study aimed to develop a nomogram to predict PPCs in thoracoscopic surgery. Methods A total of 905 patients who underwent thoracoscopy were randomly enrolled and divided into a training cohort and a validation cohort at 80%:20%. The training cohort was used to develop a nomogram model, and the validation cohort was used to validate the model. Univariate and multivariable logistic regression were applied to screen risk factors for PPCs, and the nomogram was incorporated in the training cohort. The discriminative ability and calibration of the nomogram for predicting PPCs were assessed using C-indices and calibration plots. Results Among the patients, 207 (22.87%) presented PPCs, including 166 cases in the training cohort and 41 cases in the validation cohort. Using backward stepwise selection of clinically important variables with the Akaike information criterion (AIC) in the training cohort, the following seven variables were incorporated for predicting PPCs: American Society of Anesthesiologists (ASA) grade III/IV, operation time longer than 180 min, one-lung ventilation time longer than 60 min, and history of stroke, heart disease, chronic obstructive pulmonary disease (COPD) and smoking. With incorporation of these factors, the nomogram achieved good C-indices of 0.894 (95% confidence interval (CI) [0.866–0.921]) and 0.868 (95% CI [0.811–0.925]) in the training and validation cohorts, respectively, with well-fitted calibration curves. Conclusion The nomogram offers good predictive performance for PPCs after thoracoscopic surgery. This model may help distinguish the risk of PPCs and make reasonable treatment choices.
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Affiliation(s)
- Bin Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhenxing Chen
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ru Zhao
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ye Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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van Schelt M, Jenniskens K, Rentenaar RJ, Bronsveld I. Diagnostic value of routine chest tube tip culture in surgery for noninfectious lung disease. J Cardiothorac Surg 2021; 16:329. [PMID: 34758852 PMCID: PMC8582142 DOI: 10.1186/s13019-021-01713-6] [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: 08/17/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluation of the diagnostic value of routine chest tube tip culture for detection of postoperative infection after surgery for noninfectious lung disease. METHODS Included subjects were patients who underwent lung surgery between January 1st 2013 and January 1st 2018 in University Medical Centre Utrecht and of whom a chest tube tip was cultured. Postoperative outcomes included pneumonia, surgical site infection, and empyema within 30 days after surgery. Univariable analysis for diagnostic accuracy of chest tube tip culture results predicting these postoperative outcomes was performed, as well as multivariable analysis using penalized firth logistic regression. RESULTS Patients developed one or more postoperative infections in 42 out of 210 (20%) lung surgeries. Pneumonia, surgical site infection, and empyema were found in 36 (17%), 8 (4%), and 2 (1%) cases respectively. Chest tube tip culture had a sensitivity of 31%, a specificity of 83%, a positive predictive value of 32%, and a negative predictive value of 83% for postoperative infections. In the subgroup of patients who did not have evidence of postoperative infection at the time of chest tube removal, the drain tip culture's positive and negative predictive value changed to 18% and 92% respectively. Adding additional variables to chest tube tip culture in a prediction model resulting in only limited improvement in diagnostic performance. CONCLUSIONS We found insufficient diagnostic performance to support the practice of routine chest tube tip culture after surgery for noninfectious lung disease. Therefore, routine chest tube tip culture is not advisable and should be omitted to unburden the healthcare process and prevent low value care together with extra costs.
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Affiliation(s)
- Martijn van Schelt
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Kevin Jenniskens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rob J Rentenaar
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inez Bronsveld
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
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40
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Pickering O, Pucher PH, De'Ath H, Abuawwad M, Kelly J, Underwood TJ, Noble F, Byrne JP. Minimally Invasive Approach in Boerhaave's Syndrome: Case Series and Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 31:1254-1261. [PMID: 33400893 DOI: 10.1089/lap.2020.0751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Boerhaave's syndrome is a life-threatening spontaneous perforation of the esophagus associated with significant morbidity and mortality. Historically, thoracotomy has been the mainstay of treatment, but is associated with high morbidity and pain. Minimally invasive approaches provide alternative treatment possibilities. This systematic review together with inclusion of a case series from a tertiary esophagogastric unit assesses current evidence focused on minimally invasive surgical management of this condition. Methods: A systematic review was conducted in line with MOOSE (Meta-analyses Of Observational Studies in Epidemiology) guidelines. Electronic databases PubMed, MEDLINE, and Cochrane Library were searched, and articles focusing on the minimally invasive management of Boerhaave's syndrome were identified and scrutinized. We also report demographics and outcomes for a consecutive case series of patients with acute Boerhaave's syndrome managed via thoracoscopy. Results: Fifteen studies were included comprising 5 retrospective cohort studies and 10 case reports. Management strategies were divided into three categories: thoracoscopic, endoscopic, and laparoscopic. Overall mortality rates for each treatment modality were 2%, 13%, and 33%, and treatment success rates 98%, 38%, and 67%, respectively. Postoperative infective complications were seen in 79% of patients, with only 2 patients requiring salvage thoracotomy. In our local case series, we report 4 consecutive patients managed with thoracoscopy, with a 100% treatment success rate. Conclusion: Minimally invasive approaches in the management of Boerhaave's syndrome are safe and effective. We propose a selective management algorithm involving a minimally invasive approach to management of this life-threatening condition. Registered with local clinical outcomes team as service evaluation. (Approval number sev/0171).
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Affiliation(s)
- Oliver Pickering
- Department of General Surgery, St Mary's Hospital, Isle of Wight, Newport, United Kingdom
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Philip H Pucher
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Henry De'Ath
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
- Department of General Surgery, Frimley Park Hospital, Frimley, United Kingdom
| | - Mahmoud Abuawwad
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Jamie Kelly
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Timothy J Underwood
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Fergus Noble
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - James P Byrne
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
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Association between Drainage-Dependent Prolonged Air Leak after Partial Lung Resection and Clinical Outcomes: A Prospective Cohort Study. Ann Am Thorac Soc 2021; 19:389-398. [PMID: 34715010 DOI: 10.1513/annalsats.202103-235oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Prolonged air leak (PAL) after partial lung resection can occur due to surgical complications or in the presence of residual thoracic space. The former type results in drainage-independent air leak (DIPAL), whereas later type results in drainage-dependent air leak (DDPAL). Drainage-dependent air leak is described after thoracentesis in patients with non-expandable lung, where the thoracostomy tube can be discontinued safely despite an ongoing air leak. This distinction is clinically relevant, as in the presence of DDPAL, tube thoracostomy can be safely discontinued without the need of further interventions. OBJECTIVES To determine the frequency and clinical relevance of DDAPL and DIPAL in patients with PAL after partial lung resection. METHODS We prospectively identified consecutive patients with PAL after partial lung resection. Pleural manometry was performed 3-5 days after surgery. Pleural pressure was measured for 20 minutes after clamping the thoracostomy tube. Drainage-dependent PAL was diagnosed if the end-expiratory pleural pressure remained stable after plateauing in the absence of respiratory symptoms. RESULTS Of 225 patients underwent lung resection, we identified 22 (10%) who had a PAL (9.8%). Twenty patients had adequate pleural manometry readings. The majority, 16/20 (80%), had a DDPAL and had lower median hospital length of stay than those with a DIPAL (6.9 vs. 11 days, p=0.02). All patients with DIPAL required re-exploration surgery, whereas only one patient with DDPAL underwent re-exploration surgery . CONCLUSIONS Most PALs after partial lung resection are DDPAL. Patients with DDPAL have lower hospital length of stay and less need for re-exploration surgery, than those with DIPAL.
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Hoeijmakers F, Hartemink KJ, Verhagen AF, Steup WH, Marra E, Röell WFB, Heineman DJ, Schreurs WH, Tollenaar RAEM, Wouters MWJM. Variation in incidence, prevention and treatment of persistent air leak after lung cancer surgery. Eur J Cardiothorac Surg 2021; 61:110-117. [PMID: 34410339 PMCID: PMC8715850 DOI: 10.1093/ejcts/ezab376] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/15/2021] [Accepted: 07/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Persistent air leak (PAL; >5 days after surgery) is the most common complication after pulmonary resection and associated with prolonged hospital stay and increased morbidity. Literature is contradictory about the prevention and treatment of PAL. Variation is therefore hypothesized. The aim of this study is to understand the variation in the incidence, preventive management and treatment of PAL. METHODS Data from the Dutch Lung Cancer Audit for Surgery were combined with results of an online survey among Dutch thoracic surgeons. The national incidence of PAL and case-mix corrected between-hospital variation were calculated in patients who underwent an oncological (bi)lobectomy or segmentectomy between January 2012 and December 2018. By multivariable logistic regression, factors associated with PAL were assessed. A survey was designed to assess variation in (preventive) management and analysed using descriptive statistics. Hospital-level associations between management strategies and PAL were assessed by univariable linear regression. RESULTS Of 12 382 included patients, 9.0% had PAL, with a between-hospital range of 2.6–19.3%. Factors associated with PAL were male sex, poor lung function, low body mass index, high American Society of Anesthesiologists (ASA) score, pulmonary comorbidity, upper lobe resection, (bi)lobectomy (vs segmentectomy), right-sided tumour and robotic-assisted thoracic surgery. Perioperative (preventive) management of PAL differed widely between hospitals. When using water seal compared to suction drainage, the average incidence of PAL decreased 2.9%. CONCLUSIONS In the Netherlands, incidence and perioperative (preventive) management of PAL vary widely. Using water seal instead of suction drainage and increasing awareness are potential measures to reduce this variation.
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Affiliation(s)
- Fieke Hoeijmakers
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands.,Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | - Koen J Hartemink
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Ad F Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Willem H Steup
- Department of Surgery, HAGA Hospital, Den Haag, Netherlands
| | - Elske Marra
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | | | - David J Heineman
- Department of Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands.,Department of Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | | | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands.,Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands.,Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
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Surgery for lung cancer: postoperative changes and complications-what the Radiologist needs to know. Insights Imaging 2021; 12:116. [PMID: 34383170 PMCID: PMC8360261 DOI: 10.1186/s13244-021-01047-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/25/2021] [Indexed: 01/19/2023] Open
Abstract
Imaging findings after thoracic surgery can be misleading. Knowledge of the normal post-operative anatomy helps the radiologist to recognise life-threatening complications and conversely not to wrongly evoke a complication in cases of trivial post-operative abnormalities. In this educational article, we reviewed the expected patterns after thoracic surgery including sublobar resection, lobectomy, pneumonectomy and related techniques. Imaging aspects of frequent and less common complications and their typical imaging features are then presented.
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44
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Sullivan KA, Churchill IF, Hylton DA, Hanna WC. Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications: A Systematic Review and Meta-Analysis. Respiration 2021; 100:1114-1127. [PMID: 34274935 DOI: 10.1159/000517012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Currently, consensus on the effectiveness of incentive spirometry (IS) following cardiac, thoracic, and upper abdominal surgery has been based on randomized controlled trials (RCTs) and systematic reviews of lower methodological quality. To improve the quality of the research and to account for the effects of IS following thoracic surgery, in addition to cardiac and upper abdominal surgery, we performed a meta-analysis with thorough application of the Grading of Recommendations Assessment, Development and Evaluation scoring system and extensive reference to the Cochrane Handbook for Systematic Reviews of Interventions. OBJECTIVE The objective of this study was to determine, with rigorous methodology, whether IS for adult patients (18 years of age or older) undergoing cardiac, thoracic, or upper abdominal surgery significantly reduces30-day post-operative pulmonary complications (PPCs), 30-day mortality, and length of hospital stay (LHS) when compared to other rehabilitation strategies. METHODS The literature was searched using Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Web of Science for RCTs between the databases' inception and March 2019. A random-effect model was selected to calculate risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS Thirty-one RCTs involving 3,776 adults undergoing cardiac, thoracic, or upper abdominal surgery were included. By comparing the use of IS to other chest rehabilitation strategies, we found that IS alone did not significantly reduce 30-day PPCs (RR = 1.00, 95% CI: 0.88-1.13) or 30-day mortality (RR = 0.73, 95% CI: 0.42-1.25). Likewise, there was no difference in LHS (mean difference = -0.17,95% CI: -0.65 to 0.30) between IS and the other rehabilitation strategies. None of the included trials significantly impacted the sensitivity analysis and publication bias was not detected. CONCLUSIONS This meta-analysis showed that IS alone likely results in little to no reduction in the number of adult patients with PPCs, in mortality, or in the LHS, following cardiac, thoracic, and upper abdominal surgery.
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Affiliation(s)
- Kerrie A Sullivan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada, .,Division of Thoracic Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada,
| | - Isabella F Churchill
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Thoracic Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Danielle A Hylton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Thoracic Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Waël C Hanna
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Thoracic Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Udelsman BV, Soni M, Madariaga ML, Fintelmann FJ, Best TD, Li SSY, Chang DC, Gaissert HA. Incidence, aetiology and outcomes of major postoperative haemorrhage after pulmonary lobectomy. Eur J Cardiothorac Surg 2021; 57:462-470. [PMID: 31562514 DOI: 10.1093/ejcts/ezz266] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/19/2019] [Accepted: 08/30/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Post-lobectomy bleeding is uncommon and rarely studied. In this study, we aimed to determine the incidence of post-lobectomy haemorrhage and compare the outcomes of reoperation and non-operative management. METHODS We conducted a single-institution review of lobectomy cases from 2009 to 2018. The patients were divided into two groups based on the treatment for postoperative bleeding: reoperation or transfusion of packed red blood cells with observation. Transfusion correcting intraoperative blood loss was excluded. One or more criteria defined postoperative bleeding: (i) drop in haematocrit ≥10 or (ii) frank, sustained chest tube bleeding with or without associated hypotension. Covariates included demographics, comorbidities and operative characteristics. Outcomes were operative mortality, complications, length of hospital stay and readmission within 30 days. RESULTS Following 1960 lobectomies (92% malignant disease, 8% non-malignant), haemorrhage occurred in 42 cases (2.1%), leading to reoperation in 27 (1.4%), and non-operative management in 15 (0.8%). The median time to reoperation was 17 h. No source of bleeding was identified in 44% of re-explorations. Patients with postoperative haemorrhage were more often male (64.3% vs 41.2%; P < 0.01) and more likely to have preoperative anaemia (45.2% vs 26.5%; P = 0.01), prior median sternotomy (14.3% vs 6.0%; P = 0.04), an infectious indication (7.1% vs 1.8%; P = 0.01) and operative adhesiolysis (45.2% vs 25.8%; P = 0.01). Compared with non-operative management, reoperation was associated with fewer units of packed red blood cells transfusion (0.4 vs 1.9; P < 0.001), while complication rates were similar and 30-day mortality was absent in either group. CONCLUSIONS Haemorrhage after lobectomy is associated with multiple risk factors. Reoperation may avoid transfusion. A prospective study should optimize timing and selection of operative and non-operative management.
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Affiliation(s)
- Brooks V Udelsman
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Codman Center for Clinical Effectiveness, Massachusetts General Hospital, Boston, MA, USA
| | - Monica Soni
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | | | | | - Till D Best
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Selena Shi-Yao Li
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David C Chang
- Codman Center for Clinical Effectiveness, Massachusetts General Hospital, Boston, MA, USA
| | - Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Hugen N, Hekma EJ, Claessens NJM, Smit HJM, Reijnen MMPJ. Efficacy of an autologous blood patch for prolonged air leak, a systematic review. Ann Thorac Surg 2021; 114:1064-1071. [PMID: 34115999 DOI: 10.1016/j.athoracsur.2021.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/21/2021] [Accepted: 05/12/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prolonged air leak (PAL) following pulmonary surgery remains a clinical challenge and sometimes needs surgical reintervention. An autologous blood patch (ABP) may provide a noninvasive method to cease air leak. Its value, however, is debatable. The aim of this systematic review is to synthesize evidence regarding the efficacy of ABP in patients with PAL. METHODS A comprehensive search for published studies was performed in the Medline database, Embase and the Cochrane library. Randomized controlled trials, case-control studies and case series in which a postoperative ABP was performed were included. Findings from these studies were tabulated and data was synthesized graphically. PROSPERO registration number CRD42020157591. RESULTS A total of 8 studies was included in the analysis, comprising 151 patients. Studies demonstrated heterogeneity in ABP timing and practice and an intermediate to high risk of bias was scored. The majority of studies demonstrated a beneficial effect of the ABP, with a high rate of success of over 89%. One randomized trial did not find a difference in time to cease of air leak following ABP compared with conservative tube thoracostomy. The overall complication rate was 10%. CONCLUSIONS Quality of included studies is limited due to lack of comparison groups. Synthesized data in this review demonstrates a high rate of successful procedures and acceptable complication rates, which seems to be encouraging to justify a large randomized clinical trial on the use of ABP for patients who suffer from PAL following thoracic surgery.
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Affiliation(s)
- Niek Hugen
- Department of Thoracic Surgery, Rijnstate Hospital, Arnhem, the Netherlands; Department of Surgery, Radboud university medical center, the Netherlands.
| | - Edo J Hekma
- Department of Thoracic Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Niels J M Claessens
- Department of Respiratory Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hans J M Smit
- Department of Respiratory Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michel M P J Reijnen
- Department of Thoracic Surgery, Rijnstate Hospital, Arnhem, the Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
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Shintani Y, Yamamoto H, Sato Y, Shimizu K, Endo S, Okada M, Suzuki K, Fukuchi E, Miyata H, Chida M. A risk model for prolonged air leak after lobectomy using the National Clinical Database in Japan. Surg Today 2021; 52:69-74. [PMID: 33999269 DOI: 10.1007/s00595-021-02300-x] [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: 02/06/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of our study was to develop a clinical prediction model for prolonged air leak (PAL) after lobectomy for lung cancer using preoperative variables in a large patient dataset from the National Clinical Database (NCD) in Japan. METHODS The preoperative characteristics of 57,532 and 30,967 patients who had undergone standard lobectomy for lung cancer were derived from the 2014 to 2015 and 2016 NCD datasets, respectively. PAL was defined as air leak persisting ≥ 7 days postoperatively or requiring postoperative interventional treatment, such as pleurodesis or reoperation. Risk models were developed from the 2014 to 2015 dataset and validated using the 2016 dataset. When performing model derivation, the least absolute shrinkage and selection operator (LASSO) method were applied for parameter selection. RESULTS The rate of PAL was 4.5% in 2014-2015 and 5.3% in 2016. The age, sex, body mass index, comorbid interstitial pneumonia, smoking habits, forced expiratory volume in 1 s, tumor histology, multiple lung cancer, and tumor location were selected as important variables for PAL. Our risk model for predicting PAL was fair with a concordance index of 0.6895. CONCLUSION The LASSO-based risk model for PAL after lobectomy provided important preoperative variables for PAL and risk weighting for each variable.
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Affiliation(s)
- Yasushi Shintani
- Japanese Association for Chest Surgery, Kyoto, Japan. .,Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Sato
- Japanese Association for Chest Surgery, Kyoto, Japan.,Faculty of Medicine, Department of Thoracic Surgery, University of Tsukuba, Ibaraki, Japan
| | - Kimihiro Shimizu
- Japanese Association for Chest Surgery, Kyoto, Japan.,Division of Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shunsuke Endo
- Japanese Association for Chest Surgery, Kyoto, Japan.,Department of Thoracic Surgery, Jichi Medical University, Tochigi, Japan
| | - Morihito Okada
- Japanese Association for Chest Surgery, Kyoto, Japan.,Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Kenji Suzuki
- Japanese Association for Chest Surgery, Kyoto, Japan.,Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Eriko Fukuchi
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masayuki Chida
- Japanese Association for Chest Surgery, Kyoto, Japan.,Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
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Puente-Maestú L, López E, Sayas J, Alday E, Planas A, Parise DJ, Martínez-Borja M, Garutti I. The effect of immediate postoperative Boussignac CPAP on adverse pulmonary events after thoracic surgery: A multicentre, randomised controlled trial. Eur J Anaesthesiol 2021; 38:164-170. [PMID: 33186306 DOI: 10.1097/eja.0000000000001369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The effectiveness of prophylactic continuous positive pressure ventilation (CPAP) after thoracic surgery is not clearly established. OBJECTIVE The aim of this study was to assess the effectiveness of CPAP immediately after lung resection either by thoracotomy or thoracoscopy in preventing atelectasis and pneumonia. DESIGN A multicentre, randomised, controlled, open-label trial. SETTINGS Four large University hospitals at Madrid (Spain) from March 2014 to December 2016. PATIENTS Immunocompetent patients scheduled for lung resection, without previous diagnosis of sleep-apnoea syndrome or severe bullous emphysema. Four hundred and sixty-four patients were assessed, 426 were randomised and 422 were finally analysed. INTERVENTION Six hours of continuous CPAP through a Boussignac system versus standard care. MAIN OUTCOME MEASURES Primary outcome: incidence of the composite endpoint 'atelectasis + pneumonia'. Secondary outcome: incidence of the composite endpoint 'persistent air leak + pneumothorax'. RESULTS The primary outcome occurred in 35 patients (17%) of the CPAP group and in 58 (27%) of the control group [adjusted relative risk (ARR) 0.53, 95% CI 0.30 to 0.93]. The secondary outcome occurred in 33 patients (16%) of the CPAP group and in 29 (14%) of the control group [ARR 0.92, 95% CI 0.51 to 1.65]. CONCLUSION Prophylactic CPAP decreased the incidence of the composite endpoint 'postoperative atelectasis + pneumonia' without increasing the incidence of the endpoint 'postoperative persistent air leaks + pneumothorax'.
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Affiliation(s)
- Luis Puente-Maestú
- From the Servicio de Neumología Hospital General Universitario Gregorio Marañón (LP-M), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (LP-M, IG), Facultad de Medicina Universidad Complutense de Madrid (UCM) (LP-M, EL, JS, IG), Servicio de Anestesia Hospital General Universitario Gregorio Marañón (IG), Servicio de Anestesia Hospital General Universitario 12 de Octubre (EL), Instituto de Investigación Sanitaria 12 de Octubre (I+12) (EL, JS), Servicio de Neumología Hospital General Universitario 12 de Octubre (JS), Servicio de Anestesia Hospital General Universitario La Princesa (EA, AP), Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS La Princea) (EA, AP), Facultad de Medicina Universidad Autónoma de Madrid (UAM) (EA, AP), Servicio de Anestesia Hospital General Universitario Ramón y Cajal (DJP, MM-B), Instituto de Investigación Sanitaria Hospital Ramón y Cajal (IRICYS) (DJP, MM-B), Facultad de Medicina Universidad de Alcalá de Henares (UAH), Madrid, Spain (DJP, MM-B)
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Tran Z, Chervu N, Williamson C, Verma A, Hadaya J, Gandjian M, Revels S, Benharash P. The Impact of Expedited Discharge on 30-Day Readmission Following Lung Resection: A National Study. Ann Thorac Surg 2021; 113:1274-1281. [PMID: 33882292 DOI: 10.1016/j.athoracsur.2021.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/01/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Expedited discharge (within 24 hours) following lung resection has received scrutiny due to concerns for higher readmissions and paradoxically increased costs. The present study examined the impact of expedited discharge on hospitalization costs and unplanned readmissions using a nationally-representative sample. In addition, we sought to determine inter-hospital practice variation. METHODS Adults undergoing elective lobar or sublobar resection were identified using the 2016-2018 Nationwide Readmissions Database, while those with postoperative duration of hospitalization >5 days or experienced any perioperative complication, were excluded. Patients were classified as Expedited if postoperative hospitalization was 0 or 1 day and otherwise as Routine. Inverse probability of treatment weighing was utilized to adjust for intergroup differences. Hospitals were ranked according to risk-adjusted early discharge rates. Multivariable regression models were developed to assess the association of expedited discharge on nonelective 30-day readmissions as well as associated mortality and costs. RESULTS Of an estimated 84,152 patients, 13,834 (16.4%) comprised the Expedited group. Compared to Routine, Expedited were younger, less likely to have chronic obstructive pulmonary disease and undergo open procedures. Following adjustment, early discharge was associated with lower incremental costs (β coefficient: -$3.6K, 95%CI: -4.4 - -2.8) as well as similar readmissions (odds ratio: 0.89, 95%CI: 0.70 - 1.13) and related-mortality. Nearly half (48.1%) of all hospitals performed zero early discharges. CONCLUSIONS Expedited discharge following lung resection is a feasible management strategy and is associated with decreased costs and similar readmission risk compared to the norm. Select individuals should be strongly considered for expedited discharge following lung resection.
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Affiliation(s)
- Zachary Tran
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Catherine Williamson
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Matthew Gandjian
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sha'Shonda Revels
- Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Role of Thermal Ablation in Colorectal Cancer Lung Metastases. Cancers (Basel) 2021; 13:cancers13040908. [PMID: 33671510 PMCID: PMC7927065 DOI: 10.3390/cancers13040908] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary For a long time, surgery has been the only local treatment for pulmonary metastases. Percutaneous thermal ablation appeared in the early 2000s as a minimally invasive alternative technique to surgery for patients who were not eligible for surgery or wanted to preserve quality of life. In this review, we discuss the role of thermal ablation in the management of lung metastases of colorectal cancer, and present the main results of the literature concerning oncological outcomes (local tumor control, survival) based on 12 relevant original studies each involving a minimum of 50 patients, with a minimal follow-up of 12 months. Abstract Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.
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