Are chest drains routinely required after thoracic surgery? A drainology study of on-table chest-drain removals.
Are chest drains routinely required after thoracic surgery? A drainology study of on-table chest-drain removals.
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DOI：
10.1016/j.xjon.2023.05.009
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发表时间：
2023-12
期刊：
影响因子：
--
通讯作者：
Lim, Eric
中科院分区：
文献类型：
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作者：
Abdul Khader, Ashiq;Pons, Aina;Palmares, Abigail;Booth, Sarah;Proli, Chiara;De Sousa, Paulo;Lim, Eric
胸外科围手术期管理的进步通过减少术后疼痛和并发症的发生率，加速了患者的术后恢复。我们的目的是研究在选定的病例中在手术台上清除胸腔引流液是否安全。这是一个5年的回顾性分析，在手术台上的协议胸腔引流。通过胸腔镜入路（视频胸腔镜手术）切除肺叶下/楔形肺切除术和其他小型胸部手术（胸膜活检，纵隔肿块活检/切除术）的患者的胸腔引流液。如果数字漏管记录的漏气量小于20ml /min，则在手术结束时取出胸腔引流管。引流术后的气胸、积液和进一步干预的结果数据是通过回顾术后胸片获得的，所有这些数据都是由放射科医生报告的。2016年至2021年期间，107名患者在手术室进行了引流术。平均年龄（标准差）为58（17）岁，男性54（50.5%）。引流术后发生气胸22例（21%），胸腔积液6例（5.6%），22例术后气胸中有21例采用保守处理，未再次插入胸腔引流液。由于我们的标准政策是在接受手术治疗的原发性自发性气胸患者中不留下气胸，因此只有1例（0.9%）患者重新插入了引流管。住院时间中位数（四分位数间）为1天（1-2），14例（13%）患者在手术当天出院。我们的研究结果表明，在选定的病例中，使用数字引流器进行桌上胸腔引流术是安全且可重复的，挑战了胸外科手术后常规引流术的做法。
Advances in perioperative management for thoracic surgery have accelerated the postoperative recovery of patients by decreasing postoperative pain and the incidence of complications. We aimed to study whether it's safe to remove chest drains on table in selected cases. This was a 5-year retrospective analysis of protocolized chest-drain removal on the operating table. The chest drain was removed in patients undergoing sublobar/wedge lung resection and other minor thoracic procedure (pleural biopsy, mediastinal mass biopsy/resection) via a thoracoscopic approach (video-assisted thoracoscopic surgery). Chest drains were removed at the end of the operation if air leak as documented by the digital drain was less than 20 mL/min. Outcome data on postdrain removal pneumothorax, effusion, and need for further intervention were obtained by reviewing the postoperative chest films, all reported by a radiologist. Between 2016 and 2021, 107 patients underwent drain removal in theater. Mean age (standard deviation) was 58 (17) years and 54 (50.5%) were male. Postdrain removal pneumothorax occurred in 22 patients (21%), pleural effusion in 6 (5.6%), and 21 of 22 postoperative pneumothoraces were managed conservatively without reinsertion of chest drain. As it is our standard policy to leave no pneumothorax in patients undergoing surgical management of primary spontaneous pneumothorax, only 1 such patient (0.9%) had a drain reinserted as a result. The median (interquartile) length of hospital stay was 1 day (1-2), and 14 patients (13%) were discharged on surgery day. Our results demonstrate that on table chest-drain removal in selected cases is safe and repeatable using a digital drain, challenging the practice of routine drain insertion after thoracic surgery.