Impact of Surgical Approach for Lung Transplantation on Clinical Outcomes Regarding Patient Recovery

Abstract

<h3>Purpose</h3> There is a paucity of evidence on surgical approach within lung transplantation and clinically relevant outcomes. <h3>Methods</h3> Retrospective cohort single-centre study of patients who underwent single and double lung transplantation between September 2017 and August 2021. Outcome variables were: length of stay in our Intensive Care Unit (ICU), duration of mechanical ventilation, postoperative haemorrhage within the first 24 hours, and pain scores. Comparisons of outcomes were dependent on the type of surgical access performed (Thoracotomy (T), Sternotomy (S) and Clamshell (C)). <h3>Results</h3> 140 patients met inclusion criteria and were included in our analysis. Sternotomy was the most frequent route of access (n=64) followed by Thoracotomy (n=54) and Clamshell incision (n=22). T group was associated with lower volumes of postoperative haemorrhage compared with S (P<0.001) and C (P=0.038) (Table 1). Additionally, T resulted in shorter durations of mechanical ventilation (vs S, P=0.0061; vs C, P<0.001) and lower length of ICU stay (vs S, P=0.021; vs C, P=0.54). However, mean pain scores were significantly higher for T compared with S (P=0.0072) and C (P=0.002). Outcome variables between S and C groups were statistically insignificant. Median blood loss in the first 24 hours from patients undergoing bilateral lung transplantation was 518mL [interquartile range (IQR) 300; 1027], single transplant patients had 375mL [175; 450]. Despite C having the lowest average pain score, the percentage requirement for epidural analgesia was highest in this group, followed by T and S. <h3>Conclusion</h3> These data support the use of Thoracotomy for single and bilateral lung transplantation where decreased risk of haemorrhagic complications, shorter recovery times and reduced hospital stay are favourable outcomes to consider. However, this may result in increasingly complex pain management postoperatively and potential for complications associated with prolonged opioid administration and epidural analgesia.