1
|
Pompili C, McLennan Battleday F, Chia WL, Chaudhuri N, Kefaloyannis E, Milton R, Papagiannopoulos K, Tcherveniakov P, Brunelli A. Poor preoperative quality of life predicts prolonged hospital stay after VATS lobectomy for lung cancer. Eur J Cardiothorac Surg 2021; 59:116-121. [PMID: 33057709 DOI: 10.1093/ejcts/ezaa245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess whether quality of life (QoL) scales are associated with postoperative length of stay (LoS) following video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer. METHODS This is a single-centre retrospective analysis on 250 consecutive patients submitted to VATS lobectomies (233) or segmentectomies (17) over a period of 3 years. QoL was assessed in all patients by the self-administration of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 questionnaire. The individual QoL scales were tested for possible association with LoS along with other objective baseline and surgical parameters using univariable and multivariable analyses. RESULTS Thirty-day cardiopulmonary and mortality rates were 22% and 2.4%. The median LoS was 4 days [interquartile range (IQR) 3-7]. Fifty-one (20%) patients remained in hospital longer than 7 days after surgery (upper quartile). General health [global health score (GHS)] (P = 0.019), physical function (P = 0.014) and role functioning (P = 0.016) scales were significantly worse in patients with prolonged stay. They were highly correlated between each other and tested separately in different logistic regression analyses. The best model resulted the one containing GHS (P = 0.032) along with age, low force expiratory volume in 1 s and carbon monoxide lung diffusion capacity and history of cerebrovascular disease. Fifty-nine patients had GHS <58 (lower interquartile value). Thirty-one percent of them experienced prolonged hospital stay (vs 17% of those with higher GHS, P = 0.027). CONCLUSIONS Preoperative patient-reported QoL was associated with prolonged postoperative hospital stay. Baseline QoL status should be taken into consideration to implement psychosocial supportive programmes in the context of enhanced recovery after surgery.
Collapse
Affiliation(s)
- Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK.,Department of Thoracic Surgery, Leeds Teaching Hospital Trust, Leeds, UK
| | - Finn McLennan Battleday
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Wei Ling Chia
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, Leeds Teaching Hospital Trust, Leeds, UK
| | | | - Richard Milton
- Department of Thoracic Surgery, Leeds Teaching Hospital Trust, Leeds, UK
| | | | | | | |
Collapse
|
2
|
Brunelli A, Chapman K, Pompili C, Chaudhuri N, Kefaloyannis E, Milton R, Tcherveniakov P, Papagiannopoulos K, Mitchell T, Bassi V. Ninety-day hospital costs associated with prolonged air leak following lung resection. Interact Cardiovasc Thorac Surg 2020; 31:507-512. [DOI: 10.1093/icvts/ivaa140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/03/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Our goal was to assess the postoperative 90-day hospital costs of patients with prolonged air leak (PAL) including costs incurred after discharge from the initial index hospitalization.
METHODS
We performed a retrospective analysis of 982 patients undergoing lobectomy (898) or segmentectomy (78) (April 2014–August 2018). A total of 167 operations were open, 780 were video-assisted thoracoscopic surgery and 28 were robotic. A PAL was defined as an air leak >5 days. The 90-day postoperative costs included all fixed and variable costs incurred during the 90 days following surgery. The postoperative costs of patients with and without PAL were compared. The independent association of PAL with postoperative 90-day costs was tested after adjustment for patient-related factors and other complications by a multivariable regression analysis.
RESULTS
PAL occurred in 261 patients (27%). Their postoperative stay was 4 days longer than that of those without PAL (9.6 vs 5.7; P < 0.0001). Compared to patients without PAL, those with PAL had 27% higher index postoperative costs [7354€, standard deviation (SD) 7646 vs 5759€, SD 7183, P < 0.0001] and 40% higher 90-day postoperative costs (18 340€, SD 23 312 vs 13 102€, SD 10 264; P < 0.0001). The relative postoperative costs (the difference between 90-day and index postoperative costs) were 50% higher in PAL patients compared to non-PAL patients (P < 0.0001) and accounted for 60% of the total 90-day costs. Multivariable regression analysis showed that PAL remained an independent factor associated with 90-day costs (P < 0.0001) along with the occurrence of other cardiopulmonary complications (P < 0.0001), male gender (P = 0.018), low carbon monoxide lung diffusion capacity (P = 0.043) and thoracotomy approach (P = 0.022).
CONCLUSIONS
PAL is associated not only with increased index hospitalization costs but also with increased costs after discharge. Evaluation of the cost-effectiveness of measures to prevent air leaks should also include post-discharge costs.
Collapse
Affiliation(s)
- Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kath Chapman
- Costing Team, Finance Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Cecilia Pompili
- Department of Thoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research, University of Leeds, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Richard Milton
- Department of Thoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter Tcherveniakov
- Department of Thoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Thomas Mitchell
- Costing Team, Finance Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Vinod Bassi
- Costing Team, Finance Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
3
|
Konstantinidis K, Kefaloyannis E. ROBOTIC THORACIC SURGERY: OVERRATED OR EVOLUTION? Chest 2019. [DOI: 10.1016/j.chest.2019.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
4
|
Brunelli A, Crockatt A, Chaudhuri N, Kefaloyannis E, Milton R, Papagiannopoulos K, Tcherveniakov P, Bassi V. Erratum to: 'Ninety-day hospital costs for anatomic lung resections' [Eur J Cardiothorac Surg 2019;55:440-445]†. Eur J Cardiothorac Surg 2019; 55:598. [PMID: 30481291 DOI: 10.1093/ejcts/ezy406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Alice Crockatt
- Costing Team, Finance Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St James's University Hospital, Leeds, UK
| | | | - Richard Milton
- Department of Thoracic Surgery, St James's University Hospital, Leeds, UK
| | | | | | - Vinod Bassi
- Costing Team, Finance Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
5
|
Brunelli A, Crockatt A, Chaudhuri N, Kefaloyannis E, Milton R, Papagiannopoulos K, Tcherveniakov P, Bassi V. Ninety-day hospital costs for anatomic lung resections†. Eur J Cardiothorac Surg 2018; 55:440-445. [DOI: 10.1093/ejcts/ezy296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Alice Crockatt
- Costing Team, Finance Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK
| | | | - Richard Milton
- Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK
| | | | | | - Vinod Bassi
- Costing Team, Finance Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
6
|
Kouritas VK, Kefaloyannis E, Tcherveniakov P, Milton R, Chaudhuri N, Brunelli A, Papagiannopoulos K. Do pleural adhesions influence the outcome of patients undergoing major lung resection?†. Interact Cardiovasc Thorac Surg 2017; 25:613-619. [DOI: 10.1093/icvts/ivx173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/17/2017] [Indexed: 11/14/2022] Open
|
7
|
Patella M, Papagiannopoulos K, Milton R, Chaudhuri N, Kefaloyannis E, Brunelli A. Operating room scheduling is not associated with early outcome following elective anatomic lung resections: a propensity score case-matched analysis. Eur J Cardiothorac Surg 2017; 51:660-666. [PMID: 28007872 DOI: 10.1093/ejcts/ezw371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/10/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate the effect of operating room scheduling on the outcome of patients undergoing elective lung resection. Methods In total, 420 patients submitted to anatomical pulmonary resections (363 lobectomies, 35 pneumonectomies, 22 segmentectomies) (April 2014-November 2015) were analysed. Ninety-two patients (22%) were operated on during weekends (Friday or Saturday) and 161 patients (38%) in the afternoon. Propensity score matching was performed to account for possible selection bias between the groups. The matched groups (weekdays versus weekends; morning versus afternoon) were compared in terms of cardiopulmonary complications, in-hospital mortality and length of stay (LOS). Results In total, 102 (24%) patients developed cardiopulmonary complications and 56 (13%) patients developed major complications. In-hospital mortality was 3.1% (13 patients). The case-matched comparison between patients operated on during the week versus those operated on during weekends (92 pairs) showed no differences of cardiopulmonary morbidity (22 vs 24, P = 0.8), major complications (14 in both groups), mortality (2 vs 4, P = 0.7) and LOS (7 vs 7.5 days, P = 0.6). The case-matched comparison between patients operated on in the morning versus those operated on in the afternoon (161 pairs) showed no differences of cardiopulmonary morbidity (32 vs 33, P = 0.9), major morbidity (17 vs 19, P = 1), mortality (7 vs 4, P = 0.5) and LOS (7.2 vs 5.9 days, P = 0.2). Conclusions In our setting, operating room scheduling did not affect early outcome following elective lung resections, confirming the appropriate structural and procedural characteristics of a dedicated Thoracic Unit.
Collapse
Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, St James's University Hospital, Leeds, UK
| | | | - Richard Milton
- Department of Thoracic Surgery, St James's University Hospital, Leeds, UK
| | | | - Emmanuel Kefaloyannis
- Department of Thoracic Surgery, St James's University Hospital, Leeds, UK,Department of Thoracic Surgery, Leeds Teaching Hospitals, Leeds, UK
| | | |
Collapse
|
8
|
George RS, Milton R, Chaudhuri N, Kefaloyannis E, Papagiannopoulos K. Totally Endoscopic (VATS) First Rib Resection for Thoracic Outlet Syndrome. Ann Thorac Surg 2016; 103:241-245. [PMID: 27659601 DOI: 10.1016/j.athoracsur.2016.06.075] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/13/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thoracic outlet syndrome (TOS) causes neurologic symptoms in 95% of cases and vascular symptoms in 5% of cases. Surgical resection is curative. Endoscopic-assisted transaxillary first rib resection has been previously reported. In this study we report a totally endoscopic video-assisted thoracoscopic surgery (VATS) approach using tailored endoscopic instruments. METHODS Ten patients (8 women; average age, 32.3 ± 5.6 years) with TOS underwent VATS first rib resection following failure of symptom improvement with physiotherapy. Symptoms were: unilateral neurogenic (n = = 7), bilateral neurogenic (n = = 2), and bilateral arterial compression (n = = 1). Three standard VATS ports were utilized. The parietal pleura and periosteum overlying the first rib were stripped avoiding injury to the neurovascular bundle. The rib was transected with an endoscopic rib cutter and resected completely in a piecemeal fashion using endoscopic bone nibblers. All periosteal remnants were trimmed releasing the neurovascular bundle completely. RESULTS Patients were discharged within 72 hours following surgery. One patient had the contralateral side treated 18 months later and another patient is awaiting the second surgery. At follow-up, 9 patients had complete resolution of their main symptoms. One patient with neurogenic TOS developed mild functional and sensational loss of the non-dominant hand that improved within 8 months with physiotherapy. CONCLUSIONS VATS first rib resection for TOS provides, unlike the classic approaches, a superior, magnified, and well-illuminated view of the thoracic inlet. It allows good posterior trimming of the first rib, release of brachial plexus, and an aesthetically pleasing result, especially in female patients.
Collapse
Affiliation(s)
- Robert S George
- Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, United Kingdom
| | - Richard Milton
- Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, United Kingdom
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, United Kingdom
| | - Emmanuel Kefaloyannis
- Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, United Kingdom
| | - Kostas Papagiannopoulos
- Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, United Kingdom.
| |
Collapse
|
9
|
George RS, Pompili C, Kefaloyannis E, Papagiannopoulos K. P-263SURGICAL TREATMENT OF TRACHEOBRONCHIAL MALACIA USING PATCH PLASTY. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
10
|
Kouritas V, Kefaloyannis E, Milton R, Chaudhuri N, Papagiannopoulos K, Brunelli A. O-138DOES PRESENCE OF PLEURAL ADHESIONS ALTER THE OUTCOME OF PATIENTS UNDERGOING MAJOR LUNG RESECTION? Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
Patella M, Kostoulas N, Papagiannopoulos K, Milton R, Chaudhuri N, Kefaloyannis E, Brunelli A. B-006THE INFLUENCE OF OPERATING ROOM SCHEDULING ON EARLY OUTCOME FOLLOWING ELECTIVE ANATOMIC LUNG RESECTIONS. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
12
|
Drosos P, Pompili C, Ismail H, Tentzeris V, Papagiannopoulos K, Milton R, Chaudhuri N, Kefaloyannis E, Brunelli A. O-015FACTORS ASSOCIATED WITH POSTOPERATIVE COSTS FOLLOWING ANATOMIC LUNG RESECTIONS WITHOUT MAJOR COMPLICATIONS. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
13
|
Pompili C, White J, Velikova G, O'Connor T, Ying JM, Dixon S, Kefaloyannis E, Brunelli A. O-025POOR PREOPERATIVE PATIENT-REPORTED QUALITY OF LIFE IS ASSOCIATED WITH COMPLICATIONS FOLLOWING PULMONARY LOBECTOMY FOR LUNG CANCER. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
14
|
Kouritas VK, Kefaloyannis E, Milton R, Chaudhuri N, Papagiannopoulos K, Brunelli A. Performance of wider parenchymal lung resection than preoperatively planned in patients with low preoperative lung function performance undergoing video-assisted thoracic surgery major lung resection. Interact Cardiovasc Thorac Surg 2016; 23:889-894. [PMID: 27516423 DOI: 10.1093/icvts/ivw241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 04/24/2016] [Accepted: 04/29/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Pulmonary assessment before major lung resections is used to determine patient's operability. In marginal cases, extensive pulmonary assessment is additionally important under the fear of a more radical parenchymal removal. This study investigates the outcome of wider lung parenchymal resections in patients with low lung functional status undergoing video-assisted thoracic surgery (VATS) major lung resection. METHODS The medical records of patients who underwent VATS major lung resection for cancer, over a period of 5 years (August 2009-August 2014), were retrospectively reviewed. Patients with postoperative forced expiratory volume in first second (ppoFEV1) or postoperative diffusional capacity for carbon monoxide (ppoDLCO) <40% who underwent wider lung resection than preoperatively planned (Group A) were compared with patients with ppoFEV1 or ppoDLCO <40% who underwent the planned operation (Group B) and patients with ppoFEV1 and ppoDLCO >40% who underwent wider resection than preoperatively planned (Group C). Data analysed included demographics, past medical history, the surgery planned and performed, the reason for higher parenchymal resection, the clinical and pathological stage, the length of stay (LOS), the morbidity, the 30-day mortality and the survival. RESULTS Overall, 73 patients were analysed (15 patients in Group A, 50 patients in Group B and 8 patients in Group C). The mean age was 68.5 years and 31.5% were males. The wider lung resection regarded 7 patients who underwent bilobectomy instead of lobectomy and 16 patients who underwent pneumonectomy instead of lobectomy. The main reason for higher resection was the wider invasion of the mass (21 patients). The age, gender and body mass index between three groups were similar, whereas ppoFEV1 and ppoDLCO were different (P < 0.001 and P < 0.001 respectively). Conversions, pulmonary morbidity and the 30-day mortality between groups were similar (P = 0.67, P = 0.88 and P = 0.33, respectively). LOS between groups was not different (P = 0.46). Survival rate between groups was also similar (log-rank, P = 0.79). CONCLUSIONS Wider lung parenchymal resection than preoperatively anticipated may be performed, even in patients with low lung functional status, without increased adverse outcome when compared with patients with good lung function. This finding indicates that the preoperative risk stratification based on lung function tests is questionable.
Collapse
Affiliation(s)
| | | | - Richard Milton
- Department of Thoracic Surgery, St James's University Hospital, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St James's University Hospital, Leeds, UK
| | | | | |
Collapse
|
15
|
Vallance A, Tcherveniakov P, Bogdan C, Chaudhuri N, Milton R, Kefaloyannis E. The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy. Ann R Coll Surg Engl 2016; 99:129-133. [PMID: 27502339 DOI: 10.1308/rcsann.2016.0253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Unplanned conversion to thoracotomy remains a major concern in video assisted thoracoscopic surgery (VATS) lobectomy. This study aimed to investigate the development of a VATS lobectomy programme over a five-year period, with a focus on the causes and consequences of unplanned conversions. METHODS A single centre retrospective review was performed of patients who underwent complete anatomical lung resection initiated by VATS between January 2010 and April 2015. RESULTS In total, 1,270 patients underwent a lobectomy in the study period and 684 (53.9%) of these were commenced thoracoscopically. There were 75 cases (10.9%) with unplanned conversion. The proportion of lobectomies started as VATS was significantly higher in the second half of the study period (2010-2012: 277/713 [38.8%], 2013-2015: 407/557 [73.1%], p<0.001). The conversion rate dropped initially from 20.4% (11/54) in 2010 to 9.9% (15/151) in 2013 and then remained consistently under 10% until 2015. Conversions were most commonly secondary to vascular injury (26/75, 34.7%). Patients undergoing unplanned conversion had a longer length of stay than VATS completed patients (9 vs 6 days, p<0.001). There was a higher incidence of respiratory failure (10/75 [14.1%] vs 23/607 [3.8%], p<0.001) and 30-day mortality (7/75 [9.3%] vs 6/607 [1.0%], p=0.003) in patients with unplanned conversion than in those with completed VATS. CONCLUSIONS As our VATS lobectomy programme developed, the unplanned conversion rate dropped initially and then remained constant at approximately 10%. With increasing unit experience, it is both safe and technically possible to complete the majority of lobectomy procedures thoracoscopically.
Collapse
Affiliation(s)
| | | | - C Bogdan
- Leeds Teaching Hospitals NHS Trust , UK
| | | | - R Milton
- Leeds Teaching Hospitals NHS Trust , UK
| | | |
Collapse
|
16
|
Wan Y, Kefaloyannis E. Penetrating chest injury caused by self-inflicted crossbow arrow traversing the hemithorax. Eur J Cardiothorac Surg 2016; 50:580. [PMID: 26987878 DOI: 10.1093/ejcts/ezw084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/23/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yizhou Wan
- Department of Thoracic Surgery, St. James University Hospital, Leeds, UK
| | | |
Collapse
|
17
|
Brunelli A, Tentzeris V, Sandri A, McKenna A, Liew SL, Milton R, Chaudhuri N, Kefaloyannis E, Papagiannopoulos K. A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme. Eur J Cardiothorac Surg 2015; 49:1492-6. [DOI: 10.1093/ejcts/ezv339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/03/2015] [Indexed: 12/25/2022] Open
|
18
|
Sandri A, Papagiannopoulos K, Milton R, Kefaloyannis E, Chaudhuri N, Poyser E, Spencer N, Brunelli A. Major morbidity after video-assisted thoracic surgery lung resections: a comparison between the European Society of Thoracic Surgeons definition and the Thoracic Morbidity and Mortality system. J Thorac Dis 2015; 7:1174-80. [PMID: 26380733 DOI: 10.3978/j.issn.2072-1439.2015.06.07] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND The thoracic morbidity and mortality (TM&M) classification system univocally encodes the postoperative adverse events by their management complexity. This study aims to compare the distribution of the severity of complications according to the TM&M system versus the distribution according to the classification proposed by European Society of Thoracic Surgeons (ESTS) Database in a population of patients submitted to video assisted thoracoscopic surgery (VATS) lung resection. METHODS A total of 227 consecutive patients submitted to VATS lobectomy for lung cancer were analyzed. Any complication developed postoperatively was graded from I to V according to the TM&M system, reflecting the increasing severity of its management. We verified the distribution of the different grades of complications and analyzed their frequency among those defined as "major cardiopulmonary complications" by the ESTS Database. RESULTS Following the ESTS definitions, 20 were the major cardiopulmonary complications [atrial fibrillation (AF): 10, 50%; adult respiratory distress syndrome (ARDS): 1, 5%; pulmonary embolism: 2, 10%; mechanical ventilation >24 h: 1, 5%; pneumonia: 3, 15%; myocardial infarct: 1, 5%; atelectasis requiring bronchoscopy: 2, 10%] of which 9 (45%) were reclassified as minor complications (grade II) by the TM&M classification system. According to the TM&M system, 10/34 (29.4%) of all complications were considered minor (grade I or II) while 21/34 (71.4%) as major (IIIa: 8, 23.5%; IIIb: 4, 11.7%; IVa: 8, 23.5%; IVb: 1, 2.9%; V: 3, 8.8%). Other 14 surgical complications occurred and were classified as major complications according to the TM&M system. CONCLUSIONS The distribution of postoperative complications differs between the two classification systems. The TM&M grading system questions the traditional classification of major complications following VATS lung resection and may be used as an additional endpoint for outcome analyses.
Collapse
Affiliation(s)
- Alberto Sandri
- Department of thoracic surgery, St. James's University Hospital, Leeds, UK
| | | | - Richard Milton
- Department of thoracic surgery, St. James's University Hospital, Leeds, UK
| | | | - Nilanjan Chaudhuri
- Department of thoracic surgery, St. James's University Hospital, Leeds, UK
| | - Emily Poyser
- Department of thoracic surgery, St. James's University Hospital, Leeds, UK
| | - Nicholas Spencer
- Department of thoracic surgery, St. James's University Hospital, Leeds, UK
| | | |
Collapse
|
19
|
Sandri A, Papagiannopoulos K, Milton R, Chaudhuri N, Kefaloyannis E, Pompili C, Tentzeris V, Brunelli A. High-risk patients and postoperative complications following video-assisted thoracic surgery lobectomy: a case-matched comparison with lower-risk counterparts†. Interact Cardiovasc Thorac Surg 2015; 21:761-5. [PMID: 26362624 DOI: 10.1093/icvts/ivv254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To assess the postoperative incidence of major complications in high-risk patients following video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer compared with their lower risk counterparts. METHODS A retrospective analysis on prospectively collected data of 348 consecutive patients subjected to VATS lobectomy (August 2012-September 2014) was performed. Patients were defined as high risk if one or more of the following characteristics were present: age >75 years, forced expiratory volume in 1 s (FEV1) <50%, carbon monoxide lung diffusion capacity (DLCO) <50%, history of coronary artery disease (CAD). Severity of complications was graded using the Thoracic Morbidity and Mortality (TM&M) score; major complications were defined if the TM&M score was greater than 2. The propensity score was used to match high-risk patients with their lower risk counterparts in order to minimize the influence of other confounders on outcome. The following variables were used to construct the propensity score: gender, side of operation, body mass index, American Society of Anaesthesiologists score, Eastern Cooperative Oncology Group score, Charlson's Comorbidity Index, number of functioning segments resected. RESULTS The high-risk group consisted of 141 patients (age >75 years: 84 patients; FEV1 <50: 14 patients; DLCO <50: 25 patients; history of CAD: 37 patients). The propensity score yielded two groups of 135 patients (high-risk vs low-risk) well matched for several baseline characteristics except for a lower performance status in the higher-risk group. Compared with their low-risk counterparts, high-risk patients had a higher incidence of cardiopulmonary complications (28 cases, 21% vs 14 cases, 10%; P < 0.0001) and major cardiopulmonary complications (12 cases, 9% vs 3 cases, 2%; P < 0.0001). Postoperative stay was 3 days longer in high-risk patients (8.6 vs 5.5 days, P = 0.0031). The 30-day or in-hospital mortality rates were not different between the two groups (2 cases, 1.5% vs 3 cases, 2.2%, P = 0.93). CONCLUSIONS The incidence of major complications after VATS lobectomy in high-risk patients is low, but not negligible. This information can be used when discussing surgical risk with the patient during preoperative counselling.
Collapse
Affiliation(s)
- Alberto Sandri
- Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK
| | | | - Richard Milton
- Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK
| | - Emmanuel Kefaloyannis
- Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK
| | - Cecilia Pompili
- Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK
| | - Vasileios Tentzeris
- Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK
| |
Collapse
|
20
|
Patella M, Sandri A, Pompili C, Papagiannopoulos K, Milton R, Chaudhuri N, Kefaloyannis E, Brunelli A. Real-time monitoring of a video-assisted thoracoscopic surgery lobectomy programme using a specific cardiopulmonary complications risk-adjusted control chart. Eur J Cardiothorac Surg 2015; 49:1070-4; discussion 1074. [DOI: 10.1093/ejcts/ezv294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/27/2015] [Indexed: 12/25/2022] Open
|
21
|
Kostopanagiotou K, George RS, Kefaloyannis E, Papagiannopoulos K. Novel technique in managing bronchobiliary fistula in adults: Endobronchial embolization using silicone spigots in 2 cases. Ann Thorac Med 2015; 10:67-8. [PMID: 25593611 PMCID: PMC4286849 DOI: 10.4103/1817-1737.146889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/07/2014] [Indexed: 11/04/2022] Open
Abstract
Bronchobiliary fistula (BBF) can complicate most hepatic pathologies. This is a challenging group of patients, especially when surgery is precluded. The bronchoscopic application of silicon spigots is a recognized technique for the treatment of massive hemoptysis and the management of patients with bronchopleural fistula following lung resection. Their role in the treatment of BBF has never been described. In this paper we report the successful embolization using silicon spigots in two patients with BBF secondary to malignant disease, when all surgical options were exhausted.
Collapse
Affiliation(s)
| | - Robert S George
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | | | | |
Collapse
|
22
|
Hristova R, Bogdan C, Kostopanagiotou K, Vachlas K, Kefaloyannis E, Milton R, Papagiannopoulos K, Chaudhuri N. P-206 * NEGATIVE PRESSURE WOUND THERAPY. A NOVEL ADJUNCT IN THE TREATMENT OF POSTOPERATIVE SEVERE SURGICAL EMPHYSEMA. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Tentzeris V, Kefaloyannis E, Begum S, Hristova R, Milton R, Chaudhuri N, Thorpe A, Papagiannopoulos K. F-055 * BUILDING UP A VIDEO-ASSISTED THORACOSCOPIC LUNG RESECTION PROGRAMME: ELEMENTS TO IMPROVE FAST ADOPTION. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
Hristova R, Pompili C, Begum S, Salati M, Kefaloyannis E, Tentzeris V, Papagiannopoulos K, Brunelli A. O-105 * AN AGGREGATE SCORE TO PREDICT THE RISK OF LARGE PLEURAL EFFUSION AFTER PULMONARY LOBECTOMY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
25
|
Khawaja SA, Hristova R, Thorpe A, Kefaloyannis E, Milton R, Papagiannopoulos K, Chaudhuri N. P-160IS UK STILL IN THE EUROZONE? VALIDATING AN OFF-THE-SHELF RISK SCORING SYSTEM: A PROSPECTIVE AUDIT. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
26
|
Portinos A, Kefaloyannis E, Philippakis G, Dountsis A, Zisis C, Bellenis I. Simultaneous bilateral carotid endarterectomy under local anesthesia. Asian Cardiovasc Thorac Ann 2008; 16:327-8. [PMID: 18670030 DOI: 10.1177/021849230801600416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 75-year-old man with bilateral carotid stenosis and severe coronary artery disease underwent successful simultaneous bilateral carotid endarterectomy under local anesthesia. A few days later, coronary artery bypass grafting was performed with no complications.
Collapse
Affiliation(s)
- Athanassios Portinos
- Department of Thoracic & Vascular Surgery, Evagelismos General Hospital, Athens, Greece.
| | | | | | | | | | | |
Collapse
|