Abstract
ObjectiveTo identify the predictive factors associated with pleural drainage volume (PDV) after uniportal video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC).MethodsA total of 440 consecutive NSCLC patients who underwent uniportal VATS lobectomy were enrolled in this study between November 2016 and July 2019. Thirty-four parameters, including patients’ clinicopathological characteristics and other potential predictors were collected. Daily drainage volume was summed up as PDV. Univariate analysis and multivariate regression models were fitted to identify independent predictive factors for PDV.ResultsThe median PDV was 840 ml during the median drainage duration of 4 days. A strong correlation was observed between PDV and drainage duration (correlation coefficient = 0.936). On univariate analysis, age, forced expiratory volume in 1 s % predicted (FEV1%), left ventricular ejection fraction (LVEF), operation time, serum total protein (TP), and body mass index (BMI) showed a significant correlation with PDV (P value, < 0.001, < 0.001, 0.003, 0.008, 0.028, and 0.045, respectively). Patients with smoking history (P = 0.030) or who underwent lower lobectomy (P = 0.015) showed significantly increased PDV than never smokers or those who underwent upper or middle lobectomy, respectively. On multivariate regression analysis, older age (P< 0.001), lower FEV1% (P< 0.001), lower LVEF (P = 0.011), lower TP (P = 0.013), and lower lobectomy (P = 0.016) were independent predictors of increased PDV.ConclusionsPredictive factors of PDV can be identified. Based on these predictors, patients can be treated with tailored individualized safe chest tube management.
Highlights
Postoperative chest tube placement to drain pleural fluid is an important procedure after thoracic surgery
The uniform standard may not be the appropriate threshold level for different patients as the ability of the pleura for filtration and reabsorption vastly differs from patient to patient
Using the multiple backward regression strategy, age (P < 0.001), FEV1% (P < 0.001), left ventricular ejection fraction (LVEF) (P = 0.011), total protein (TP) (P = 0.013), and lower lobectomy (P = 0.016) were included in the final model
Summary
Postoperative chest tube placement to drain pleural fluid is an important procedure after thoracic surgery. The threshold of daily drainage volume depends on the experience of different surgeons [5]. This threshold varies widely; it can be 2 ml/kg body weight [6], or it can be 100 ml [7], 200 ml [8], or even 500 ml per day [9]. The uniform standard may not be the appropriate threshold level for different patients as the ability of the pleura for filtration and reabsorption vastly differs from patient to patient. Under this circumstance, a thoracic surgeon should be able to accurately predict the drainage volume for appropriate chest tube management
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