PSU3 OUTCOME IMPROVEMENT AND HOSPITAL STAY REDUCTION IN LUNG REDUCTION SURGERIES

Abstract

One of the most common complications after a lung reduction surgery is prolonged air leak. This study reports the routine use of Heimlich valve and its impact on total hospital stay and a re-operation for a persistent leak. This article evaluates electronic health records to assess the impact of this treatment and the results also show a prospective algorithm for treatment of persistent air leaks. From September 2005, through November 2011, 150 patients were operated for elective pulmonary resection, which had a heterogenous pattern of lung disease, with post-operative mortality of 4 patients and average duration of total length of hospital stay of 10.61 days. Bilateral Heimlich valves were applied to 18 patients, and unilateral Heimlich valves in 132 patients. Use of Heimlich valve was done irrespective of size of air leak. X-rays were obtained in patients after Heimlich valve was placed which showed minimal size of air leak. Mean number of postoperative days to placement of the Heimlich valve was 7.2 ± 2.4. The mean number of days to postoperative discharge was 8.1 ± 1.6(range5 to 16) and the mean number of days after discharge until removal of the chest tubes and the Heimlich valves was 3.61 ± 1.4(range 0, to 26). Almost all patient tolerated Heimlich valve well after discharge. The average hospital stay was shortened by 56% with the use of Heimlich valve in patients who underwent lung reduction surgery, considering the fact that all these patients would have stayed in the hospital, till the removal of their chest tube. The reduced hospital stay has certainly been caused by the use of Heimlich valve. This eventually helps in providing better patient care.The algorithm to predict the severity of air leak clinically was found to be effective in determining the course of decision making.