1
|
Lobdell KW, Perrault LP, Drgastin RH, Brunelli A, Cerfolio RJ, Engelman DT. Drainology: Leveraging research in chest-drain management to enhance recovery after cardiothoracic surgery. JTCVS Tech 2024; 25:226-240. [PMID: 38899104 PMCID: PMC11184673 DOI: 10.1016/j.xjtc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Kevin W. Lobdell
- Sanger Heart & Vascular Institute, Wake Forest University School of Medicine, Advocate Health, Charlotte, NC
| | - Louis P. Perrault
- Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | - Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | | | - Daniel T. Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass
| |
Collapse
|
2
|
Zhu J, Xia X, Li R, Song W, Zhang Z, Lu H, Li Z, Guo Q. Efficacy and safety of early chest tube removal after selective pulmonary resection with high-output drainage: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33344. [PMID: 36961179 PMCID: PMC10036022 DOI: 10.1097/md.0000000000033344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/01/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND There is controversy over the drainage threshold for removal of chest tubes in the absence of significant air leakage after selective pulmonary resection. METHODS A comprehensive search of online databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, Ovid, Elsevier, Ebsco, and Wiley) and clinical trial registries (WHO-ICTRP and ClinicalTrials.gov) was performed to investigate the efficacy and safety of early chest tube removal with high-output drainage. Primary outcome (postoperative hospital day) and secondary outcomes (30-day complications, rate of thoracentesis, and chest tube placement) were extracted and synthesized. Subgroup analysis, meta-regression, and sensitivity analysis were used to explore the potential heterogeneity. Study quality was assessed with the Newcastle-Ottawa Scale, and evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment by the online GRADEpro Guideline Development Tool. RESULTS Six cohort studies with a total of 1262 patients were included in the final analysis. The postoperative hospital stay in the high-output group was significantly shorter than in the conventional treatment group (weighted mean difference: -1.34 [-2.34 to -0.34] day, P = .009). While there was no significant difference between 2 groups in 30-day complications (relative ratio [RR]: 0.92 [0.77-1.11], P = .38), the rate of thoracentesis (RR: 1.93 [0.63-5.88], P = .25) and the rate of chest tube placement (RR: 1.00 [0.37-2.70], P = .99). According to the sensitivity analysis, the relative impacts of the 2 groups had already stabilized. Subgroup analysis revealed that postoperative hospital stay was modified by Newcastle-Ottawa Scale score. The online GRADEpro Guideline Development Tool presented very low quality of evidence for the available data. CONCLUSIONS This meta-analysis revealed that it is feasible and safe to remove a chest tube with high-output drainage after pulmonary resection for selected patients.
Collapse
Affiliation(s)
- Junwei Zhu
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Xueyang Xia
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Rongyao Li
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Weikang Song
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Zhiqiang Zhang
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Huawei Lu
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Zhiwei Li
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Qingwei Guo
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| |
Collapse
|
3
|
Cheng C, Wen YW, Tsai CY, Chao YK. Impact of Child-Pugh class A liver cirrhosis on perioperative outcomes of patients with oesophageal cancer: a propensity score-matched analysis. Eur J Cardiothorac Surg 2020; 59:ezaa334. [PMID: 33099615 DOI: 10.1093/ejcts/ezaa334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Advanced-stage (Child-Pugh classes B and C) liver cirrhosis (LC) is a contraindication for oesophagectomy. However, the question as to whether Child-Pugh class A LC may have an impact on perioperative outcomes remains unanswered. This retrospective single-centre study was designed to address this issue. METHODS This was a single-centre, retrospective, propensity-matched study. The perioperative outcomes of patients with Child-Pugh class A LC were compared with those of patients without LC after propensity score matching. RESULTS Out of a cohort consisting of 811 patients, we identified 51 cases with Child-Pugh class A LC. After the application of propensity score matching, the LC and no-LC groups consisted of 50 and 100 patients, respectively. The presence of LC did not compromise the quality of surgical resection as attested to by similar lymph node yields and R0 rates. However, patients with LC patients were more prone to developing postoperative pneumonia (22% vs 9%, P = 0.027), pleural effusion (38% vs 20%, P = 0.018) and chylothorax (10% vs 1%, P = 0.016) and had longer intensive care unit stay (mean: 6.10 vs 2.58 days, P = 0.002) compared with the no-LC group. Multivariable analysis identified thoracic duct ligation [odds ratio (OR) 12.292, P = 0.042] and a higher number of dissected nodes (OR 4.375, P = 0.037) as independent risk factors for chylothorax and pleural effusion, respectively. The detrimental effect of these variables was limited to the LC group. CONCLUSIONS Oesophagectomy portends a higher morbidity in patients with Child-Pugh class A LC. A meticulous management of lymphatic ducts during mediastinal dissection may improve surgical outcomes in this high-risk group.
Collapse
Affiliation(s)
- Chuan Cheng
- Department of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Department of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
4
|
Malibary N, Manfredelli S, Almuttawa A, Delhorme JB, Romain B, Brigand C, Rohr S. Evaluating the Surgeon's Experience as a Risk Factor for Post-Esophagectomy Chylothorax on a Four-Year Cohort. Cureus 2020; 12:e8696. [PMID: 32699693 PMCID: PMC7370582 DOI: 10.7759/cureus.8696] [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] [Indexed: 11/24/2022] Open
Abstract
Background: Chylothorax (CHT) is a known post-operative complication after esophageal surgery with vaguely defined risk factors. Methods: This is a retrospective chart review of 70 consecutive patients with operable cancer over a period of four years (January 2013 to December 2016). Ivor Lewis and McKeown interventions were performed. Thoracic duct is identified and ligated routinely. Factors related to the patient, the tumor, and the operating surgeon were analyzed. Results: Incidence of CHT was 10%. Surgeons with less than five years of esophageal surgery experience had the most CHT, 71% (p=0.001). No association was found between tumor location, type, body mass index (BMI), neoadjuvant therapy, response to neoadjuvant therapy or male sex, and CHT. The odds of developing CHT were 17 times higher in patients operated by a junior surgeon (odds ratio, OR=17.67, confidence interval, CI 2.68-116.34, p=0.003). Four patients (5.7%) had anastomotic leaks, none of them had CHT. Senior surgeons had less operative time and harvested more lymph nodes (p=0.0002 and p=0.1086 respectively). Conclusion: Surgeon’s experience might be considered a major risk factor to develop CHT. This finding needs to be confirmed by a larger multicentric series taking into consideration the human factor.
Collapse
Affiliation(s)
- Nadim Malibary
- Surgery, King Abdulaziz University, Jeddah, SAU.,Visceral and General Surgery, Hautepierre Hospital, Strasbourg, FRA
| | | | | | | | - Benoit Romain
- Visceral and Digestive Surgery, Hautepierre University Hospital, Strasbourg, FRA
| | - Cecile Brigand
- Visceral and Digestive Surgery, Hautepierre University Hospital, Strasbourg, FRA
| | - Serge Rohr
- Visceral and Digestive Surgery, Hautepierre University Hospital, Strasbourg, FRA
| |
Collapse
|
5
|
Zhang C, Zhang RM, Pan Y, Wu WB, Zhang M. Late-onset chylothorax during chemotherapy after lobectomy for lung cancer: A case report and review of the literature. Medicine (Baltimore) 2019; 98:e15909. [PMID: 31145354 PMCID: PMC6708882 DOI: 10.1097/md.0000000000015909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Chylothorax is usually diagnosed within a few days after lobectomy. Late-onset chylothorax following trauma or thoracic surgery is rare but potentially lethal, lacking reliable preventive methods. PATIENT CONCERNS A 54-year-old male patient complained of dyspnea during adjuvant chemotherapy on the 35th postoperative day after right middle lobectomy and systemic lymph node dissection (SLND) for lung cancer. His computed tomography indicated massive pleural effusion filling in the right chest cavity. DIAGNOSES The patient was primarily diagnosed as late-onset chylothorax, without definite evidence to exclude spontaneous chylous leakage. INTERVENTIONS Uniportal video-assisted thoracoscopic thoracic duct ligation (TDL) was performed for him, as conservative treatment using octreotide with fat-free diet turned out to be ineffective. OUTCOMES His pleural effusion was gradually diminished after reoperation, and the patient was discharged 9 days after TDL. LESSONS Postoperative late-onset or spontaneous chylothorax should be kept in mind after pulmonary resection and SLND, and the exclusion of chylous leakage could be considered as a precondition of chest tube removal.
Collapse
Affiliation(s)
- Chu Zhang
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing
| | - Rui-Mei Zhang
- Department of General Surgery, Xuzhou Infectious Disease Hospital
| | - Yong Pan
- Department of General Surgery, Xuzhou Infectious Disease Hospital
| | - Wen-Bin Wu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, China
| | - Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, China
| |
Collapse
|
6
|
Wang X, Yan S, Wang Y, Wu N. [Surgical Quality Surveillance and Sustaining Improvement of Lung Cancer Surgery Based on Standard Operation Procedure (SOP): Experience of Single Surgical Team]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:253-258. [PMID: 28442014 PMCID: PMC5999673 DOI: 10.3779/j.issn.1009-3419.2017.04.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
背景与目的 医疗流程标准化可提高治疗规范程度、控制合并症和住院时间,但国家制定的临床路径需根据各中心实际情况进行个体化调整。 方法 本研究分析单一手术组进行肺切除手术患者的围手术期信息,通过对比术后平均住院日、医疗费用、手术胸腔镜占比等多个因素,从结构性指标、过程性指标、结果性指标三个方面进行了手术质量持续改进的总结和探索,寻找适合本手术组实际情况的理想术后住院时间及质量评估指标。 结果 2016年的术后平均住院日较2013年明显缩短[(4.08±1.80) d vs (6.13±3.60) d, P < 0.001],全胸腔镜手术占比(17%→48%→68%→73%)及单操作孔胸腔镜占比(0%→2%→52%→66%)四年来显著提高。 结论 通过外科单元进行自我质量监控和改进,能够显著降低术后平均住院日,减少术后并发症发生。
Collapse
Affiliation(s)
- Xing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II,
Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shi Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II,
Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yaqi Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II,
Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Nan Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II,
Peking University Cancer Hospital & Institute, Beijing 100142, China
| |
Collapse
|