TY - JOUR
T1 - Air Leak Management Program With Digital Drainage Reduces Length of Stay After Lobectomy
AU - Mayor, Jessica M.
AU - Lazarus, Donald R.
AU - Casal, Roberto F.
AU - Omer, Shuab
AU - Preventza, Ourania
AU - Simpson, Katherine
AU - Jimenez, Ernesto
AU - Cornwell, Lorraine D.
N1 - Publisher Copyright:
© 2018 The Society of Thoracic Surgeons
PY - 2018/12
Y1 - 2018/12
N2 - Background: Air leaks can impede recovery from lung resection. To help prevent and manage air leaks, we developed a comprehensive program that includes using precompression of lung staple lines, sealant, fissureless video-assisted thoracoscopic (VATS) lobectomy, a digital drainage system, and endobronchial valve placement for prolonged air leak. We assessed the effectiveness of this program on air leak duration, hospital length of stay (LOS), and chest tube duration in our high-risk veteran population. Methods: Using a prospectively maintained database, we retrospectively analyzed data from 226 patients who underwent lung resection for cancer by VATS lobectomy in a Veterans Affairs center. Patients were divided into two groups. Group A (n = 134; historical controls) underwent lobectomy from July 2009 through October 2013; group B (n = 92; intervention group) underwent lobectomy from November 2013 through July 2016 and received care per the comprehensive program. Results: The median hospital LOS was significantly shorter in group B than in group A patients (5 days versus 6 days, respectively; p = 0.0001). Group B had a shorter median chest tube duration (2 days versus 3 days, p = 0.027). Prolonged air leak (more than 5 days) occurred in 5.4% of group B and 9.7% of group A patients (p = 0.24). Prolonged LOS (more than 14 days) was less frequent in group B (1.1%) than in group A (8.2%, p = 0.030). Multivariable analysis showed that predictors of decreased air leak duration, chest tube duration, and LOS included undergoing surgery in the later period (group B). Conclusions: Our comprehensive program was associated with reduced chest tube days and hospital LOS.
AB - Background: Air leaks can impede recovery from lung resection. To help prevent and manage air leaks, we developed a comprehensive program that includes using precompression of lung staple lines, sealant, fissureless video-assisted thoracoscopic (VATS) lobectomy, a digital drainage system, and endobronchial valve placement for prolonged air leak. We assessed the effectiveness of this program on air leak duration, hospital length of stay (LOS), and chest tube duration in our high-risk veteran population. Methods: Using a prospectively maintained database, we retrospectively analyzed data from 226 patients who underwent lung resection for cancer by VATS lobectomy in a Veterans Affairs center. Patients were divided into two groups. Group A (n = 134; historical controls) underwent lobectomy from July 2009 through October 2013; group B (n = 92; intervention group) underwent lobectomy from November 2013 through July 2016 and received care per the comprehensive program. Results: The median hospital LOS was significantly shorter in group B than in group A patients (5 days versus 6 days, respectively; p = 0.0001). Group B had a shorter median chest tube duration (2 days versus 3 days, p = 0.027). Prolonged air leak (more than 5 days) occurred in 5.4% of group B and 9.7% of group A patients (p = 0.24). Prolonged LOS (more than 14 days) was less frequent in group B (1.1%) than in group A (8.2%, p = 0.030). Multivariable analysis showed that predictors of decreased air leak duration, chest tube duration, and LOS included undergoing surgery in the later period (group B). Conclusions: Our comprehensive program was associated with reduced chest tube days and hospital LOS.
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U2 - 10.1016/j.athoracsur.2018.07.029
DO - 10.1016/j.athoracsur.2018.07.029
M3 - Article
C2 - 30218663
AN - SCOPUS:85055491945
SN - 0003-4975
VL - 106
SP - 1647
EP - 1653
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -