Tube Drainage Research Articles

Determining optimal air leak resolution criteria when using digital pleural drainage device after lung resection

ObjectiveThere is limited clinical evidence to support any specific parenchymal air leak resolution criteria when using digital pleural drainage devices following lung resection. The aim of this study is to determine an optimal air leak resolution criteria, where duration of chest tube drainage is minimized while avoiding complications from premature chest tube removal. MethodsAirflow data averaged at 10-minute intervals was collected prospectively using a digital pleural drainage device (Thopaz; Medela) in 400 patients from 2015 to 2019. All permutations of air leak resolution criteria from <10 to 100 mL/minute for 4 to 12 hours were applied retrospectively to the pleural drainage data to determine air leak duration, and air leak recurrence frequency and volume. Air leak recurrence indicates potential for rather than occurrence of adverse events. Descriptive statistics were used to identify the optimal criteria based on patient safety (low frequency and volume of air leak recurrences), and efficiency (shortest initial air leak duration). ResultsThe majority of the 400 patients underwent lobectomy (57% [227 out of 400]), wedge resections (29% [115 out of 400]), or segmentectomies (8% [32 out of 400]) for lung cancer (90% [360 out of 400]). An airflow threshold <50 mL/minute resulted in longer air leak duration before meeting the criteria for air leak resolution (P < .0001). Air leak recurrence frequency and volume were greater in patients with a monitoring period <8 consecutive hours (P < .0001). ConclusionsWhen using a digital pleural drainage device, a postoperative air leak resolution criteria <50 mL/minute for 8 consecutive hours was associated with the best safety and efficiency profile.

Design and application of a drainage tube dredging umbrella and anti-retrograde infection kit

The consensus has been reached on the benefits of surgical drainage. However, catheter-related blockage and retrograde infection remain bottleneck problems in the treatment process. To this end, with Huashan Hospital, Fudan University, as the main inventors, a drainage tube dredging umbrella and anti-retrograde infection kit have been designed and applied for the national utility model patent (patent number: ZL 2023 2 1300036.2). The main body of the kit consists of a catheter dredging umbrella, drainage tube, and drainage bag. Several isolation layers are installed in the drainage bag to form a maze structure and a reflux valve is added, thereby increasing the distance and resistance of liquid reflux, greatly reducing the possibility of liquid reflux entering the drainage tube, so as to reduce the risk of retrograde infection through physical means. When the drainage tube is blocked, the drainage tube and joint tube of the drainage bag can be separated, the unblocking umbrella can be inserted into the blockage through the guide wire, the cannula can be inserted along the guide wire, the guide wire is pulled to release the dredging umbrella in the contraction state, and the dredging umbrella can be pulled back in the expansion state until the blockage is removed from the drainage tube. The operating procedure is standardized and simple. While preventing retrograde infection (anti-retrograde infection kit), the catheter dredging umbrella could effectively address the issue of catheter blockage. It has certain clinical promotion and application value.

Outcome of surgical treatment for recurrence of biliary stones

Background: Cholelithiasis is one of the most common digestive disease, a chronic recurrent hepatobiliary disease whose pathological bases are impaired cholesterol, bilirubin and bile acid metabolism. Management of recurrent biliary stones is difficult because of the precense of deepseated intrahepatic ductal stones and ductal strictures, which are often multiple. Purpose: The objective of this study is to evaluate the efficacy and safety of surgical treatment for recurrence of biliary stone patients. Patients and Methods: Prospective analyses of the patients of recurrent biliary stones (common bile duct and intrahepatic) at Department of GI Surgery, Hue Univesity of Medicine and Pharmacy Hospital and Department of GI Surgery, Hue Central Hospital from 01/2019 to 06/2022. We evaluated the data according to outcome measures, characteristics and treatment results of recurrent cholelithiasis patients. Results: 52 patients were included into the study, mean age of the patients was 53.6±16.5 years. 44 patients (84.6%) had previous choledocholithotomy and T tube drainage during 24 months. Common bile duct stones were 69.2%, intrahepatic gallstones were 65.4%. Type of surgery included: choledocholithotomy and T tube drainage were 55.8%, left hepatectomy plus drainage were 32.6%. There was no operative mortality. Complication occurred in 13.4% of patients and half the complications involved wound ìnfection. With regard to residual stones after operation by cholangiography, there are 6 patients obviously showed residual gallstones. Follow-up examination during 3-6 months showed 90.1% of patients with good results. Conclusion: Surgical management of recurrent biliary stones (common bile duct and intrahepatic) were safe and effective. Key words: Gallstones, residual gallstones, relapse gallstone.

Effects of the enhanced recovery after surgery (ERAS) protocol on the postoperative stress state and short-term complications in elderly patients with colorectal cancer.

The aim of this study was to evaluate the feasibility and necessity of enhanced recovery after surgery in elderly patients with colorectal cancer by observing inflammatory markers and postoperative complications. Hospitalized colorectal cancer patients from the Affiliated Hospital of Jiangsu University from January 2021 to September 2022 were included in the study and divided into two groups: Enhanced Recovery After Surgery (ERAS) and non-ERAS. Data on postoperative inflammatory markers and complications were also collected. A total of 313 patients with colorectal cancer were included: 182 in the ERAS group and 131 in the non-ERAS group. The patients in the ERAS group had significantly shorter days of postoperative hospitalization, urinary catheter and drainage tube withdrawal times, and recovery of bowel function (P < .05) than those of the non-ERAS group. Moreover, the ERAS group had lower hospitalization expenses than those of the non-ERAS group (P < .05). However, the procalcitonin and tumor necrosis factor (TNF)-α levels in the ERAS group was significantly lower than those in the non-ERAS group on postoperative days 1 and 3 (P < .05), and the interleukin (IL)-6 and IL-10 levels in the ERAS group were significantly lower than those in the non-ERAS group on the 1st, 3rd, and 5th postoperative days (P < .05). The C-reactive protein (CRP) and white blood cell (WBC) levels in the ERAS group were lower than those in the non-ERAS group on postoperative days 3 and 5 (P < .05). However, the hemoglobin levels did not differ significantly (P > .05). The albumin levels did not differ significantly between the two groups before surgery (P > .05); however, the albumin level in the ERAS group was higher than that in the non-ERAS group on postoperative days 3 and 5 (P < .05). The ERAS patients had lower albumin levels after surgery than those of the non-ERAS patients (P < .05). ERAS leads to a series of perioperative optimization measures, thereby reducing the postoperative stress response in elderly patients with colorectal cancer and the occurrence of perioperative complications.

Current Status and Influencing Factors of Readiness for Hospital Discharge of Lung Cancer Patients Receiving ERAS-Guided Postoperative Management.

This study ascertained current status and influencing factors of readiness for hospital discharge (RHD) of lung cancer (LC) patients with enhanced recovery after surgery (ERAS) concept-guided postoperative management. This study prospectively and consecutively included 217 LC patients who underwent whole-course ERAS concept-guided postoperative management at the Department of Thoracic Surgery of Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical University from November 2023 to April 2024. RHD, quality of discharge teaching (QDT), and social support (SS) were evaluated using RHDS, QDTS, and SSRS, followed by correlation analyses of RHD with the other 2 factors. The clinical baseline and pathological data were compared between the high and low RHD groups, and the characteristics showing statistical significance were assigned as independent variables for regression analysis with RHD as the dependent variable. RHD, QDT, and SS were above average among LC patients with ERAS concept-guided postoperative management, and RHD was positively correlated with both QDT and SS. Age, education level, self-care ability, number of admissions, and presence of drainage tubes were independent influence factors for RHD of LC patients with ERAS concept-guided postoperative management. In LC patients with ERAS concept-guided postoperative management, RHD may be improved by increasing QDT and SS and intervened by factors such as age, education level, self-care ability, number of admissions, and presence of drainage tubes.

A nomogram model for the occurrence of bladder spasm after TURP in patients with prostate enlargement based on serum prostacyclin and 5-hydroxytryptamine and clinical characteristics.

With the development of analytical methods, mathematical models based on humoral biomarkers have become more widely used in the medical field. This study aims to investigate the risk factors associated with the occurrence of bladder spasm after transurethral resection of the prostate (TURP) in patients with prostate enlargement, and then construct a nomogram model. Two hundred and forty-two patients with prostate enlargement who underwent TURP were included. Patients were divided into Spasm group (n=65) and non-spasm group (n=177) according to whether they had bladder spasm after surgery. Serum prostacyclin (PGI2) and 5-hydroxytryptamine (5-HT) levels were measured by enzyme-linked immunoassay. Univariate and multivariate logistic regression were used to analyze the risk factors. Postoperative serum PGI2 and 5-HT levels were higher in patients in the Spasm group compared with the Non-spasm group (P<0.05). Preoperative anxiety, drainage tube obstruction, and elevated postoperative levels of PGI2 and 5-HT were independent risk factors for bladder spasm after TURP (P<0.05). The C-index of the model was 0.978 (0.959-0.997), with a χ2 = 4.438 (p = 0.816) for Hosmer-Lemeshow goodness-of-fit test. The ROC curve to assess the discrimination of the nomogram model showed an AUC of 0.978 (0.959-0.997). Preoperative anxiety, drainage tube obstruction, and elevated postoperative serum PGI2 and 5-HT levels are independent risk factors for bladder spasm after TURP. The nomogram model based on the aforementioned independent risk factors had good discrimination and predictive abilities, which may provide a high guidance value for predicting the occurrence of bladder spasm in clinical practice.

Learning curve for complex segmentectomy via uniportal video-assisted thoracoscopic surgery for the treatment of early-stage lung cancer.

Recently, segmentectomy has emerged as a viable treatment option for early-stage lung cancer. Segmentectomy can be divided into simple segmentectomy and complex segmentectomy. While simple segmentectomy is a relatively straightforward surgical procedure, complex segmentectomy poses a considerable challenge because of its intricate anatomical variations and the need for a complex surgical approach. The introduction of uniportal video-assisted thoracoscopic surgery (VATS) further complicates matters. This study aimed to assess whether thoracic surgeons, who have previously conducted only uniportal VATS lobectomy and simple segmentectomy, could effectively navigate the learning curve when undertaking their first complex segmentectomy procedure. A single surgeon with experience limited to uniportal VATS lobectomy and simple segmentectomy began performing uniportal VATS complex segmentectomy in 2019, completing 167 cases of complex segmentectomy during the same period and performing 70 cases of simple segmentectomy. We analyzed the learning curve by comparing the surgical outcomes and operative time curves between simple segmentectomy and complex segmentectomy. The complex segmentectomy group exhibited similarities with the simple segmentectomy group in terms of patient and tumor characteristics, operative outcomes, and postoperative outcomes, with the exception of the complex segmentectomy group showing slightly reduced chest tube drainage and shorter hospital stays. The operative times and time curve patterns showed no significant difference between the two groups, indicating a potential lack of a distinct learning curve for complex segmentectomy. Complex segmentectomy via uniportal VATS, when performed by surgeons proficient in simple segmentectomy and lobectomy techniques, has comparable outcomes and potentially eliminates the need for an extensive learning curve. This approach expands the options for treating early-stage non-small-cell lung cancer (NSCLC), allowing for tailored patient care. Further studies are needed to assess long-term outcomes.

Do surgical drains reduce the postoperative surgical complications following incisional hernia repair? A systematic meta-analysis.

Abdominal surgeries are common surgical procedures worldwide. Incisional hernias commonly develop after abdominal wall surgery. Surgery is the definite treatment for most incisional hernias but carries a higher rate of complications. Although frequently used, the real benefit of using drain tubes to reduce surgical complications after incisional hernia repair is uncertain. PubMed and Embase databases were searched for studies that compared the outcomes of drain vs. no-drain placement and the risk of complications in patients undergoing incisional hernia repair. Primary endpoints were infection, seroma formation, length of hospital stay, and readmission rate. From a total of 771 studies, we included 2 RCTs and 4 non-RCTs. A total of 40,325 patients were included, of which 28 497 (71%) patients used drain tubes, and 11 828 (29%) had no drains. The drain group had a significantly higher infection rate (OR 1.89; CI 1.13-3.16; P = 0.01) and mean length of hospital stay (Mean Difference-MD 2.66; 95% CI 0.81-4.52; P = 0.005). There was no difference in seroma formation and the readmission rate. This comprehensive systematic meta-analysis concluded that drain tube placement after incisional hernia repair is associated with increased infection rate and length of hospital stay without affecting the rate of seroma formation and readmission rate. Prospective randomized studies are required to confirm these findings.

Approach to mediastinal masses: a comparison of open surgery and uniportal video-assisted thoracoscopic surgery techniques

Aims: This study aimed to compare perioperative and postoperative outcomes in patients who underwent uniportal video-assisted thoracoscopic surgery (U-VATS) and open surgery for mediastinal mass resection. Methods: A total of 62 patients who underwent mediastinal mass resection in the Thoracic Surgery Clinic were included. The patients were separated into the open surgery group (n=30) and the U-VATS group (n=32). The groups were compared in terms of perioperative and postoperative outcomes including operative time, blood loss, chest tube removal time, drainage volume, pain, and hospital stay. Results: The distributions of age and gender were similar between the groups. Median operation time (120 vs. 180 minutes, P &lt; 0.001), median intraoperative blood loss (50 vs. 100 mL, P &lt; 0.001), median time of chest drain removal (4 vs. 6 days, P &lt; 0.001) and median postoperative drainage volumes were lower in the U-VATS group than the open surgery group. The U-VATS group exhibited a lower VAS score, return time to daily activity (1 vs. 4 days, P &lt; 0.001) and length of hospital stay (4 vs. 6 days, P &lt; 0.001). A postoperative myasthenic crisis was not observed in all cases. One thymoma patient in the open surgery group had a recurrence, but not in the U-VATS group. Conclusion: The U-VATS approach had better intraoperative safety and lower postoperative outcomes than open surgery. U-VATS, which has the potential to enhance postoperative recovery and quality of life, may be a safe and effective treatment option for patients with mediastinal mass resection.

Comparison of safety and efficacy of posterior lumbar interbody fusion (PLIF) and modified transforaminal lumbar interbody fusion (M-TLIF) in the treatment of single-segment lumbar degenerative diseases

ObjectiveTo compare modified transforaminal lumbar interbody fusion (M-TLIF) with posterior lumbar interbody fusion (PLIF) in the treatment of single-segment lumbar degenerative disorders in order to assess its safety and effectiveness.MethodsFrom January 2016 to January 2021, 74 patients who received single-segment M-TLIF were examined. A total of 74 patients having single-segment PLIF during the same time period were included in a retrospective controlled study using the same inclusion and exclusion criteria. The two groups were compared in terms of the fusion rate, the Oswestry disability index (ODI), the visual analogue scale of low back pain (VAS), the perioperative condition, the postoperative complications, and the postoperative neighbouring segment degeneration.ResultsAll patients had surgery satisfactorily and were monitored for at least a year afterwards. The baseline values for the two groups did not significantly differ. The interbody fusion rate between PLIF (98.65%) and M-TLIF (97.30%) was not significantly different. In the follow-up, the M-TLIF group's VAS score for low back and leg pain was lower than that of the PLIF group. The ODI score of the M-TLIF group was lower than that of the PLIF group at 7 days and 3 months following surgery. Both groups' post-op VAS and ODI scores for low back and leg pain were much lower than those from before the procedure. In M-TLIF group, the operation time, drainage tube extraction time, postoperative bed rest time and hospital stay time were shorter, and the amount of intraoperative blood loss was less. Compared with those before operation, the height of intervertebral space and intervertebral foramen were significantly increased in both groups during postoperative follow-up (P < 0.05). The postoperative complications and adjacent segment degeneration of M-TLIF were significantly lower than those of PLIF.ConclusionsM-TLIF is a safe and effective treatment for lumbar degenerative disorders, with a high fusion rate and no significant difference between M-TLIF and PLIF. M-TLIF's efficacy and safety are comparable to that of PLIF, particularly in terms of early relief of low back pain and improvement in quality of life following surgery. Therefore, M-TLIF technology can be popularized and applied in clinic.

The effect of placing prophylactic abdominal drainage tube after hepatobiliary surgery on postoperative infection: A systematic review and meta‐analysis

AbstractWhether prophylactic abdominal drainage tube is routinely placed in patients after hepatobiliary surgery remains controversial. To evaluate the effect of prophylactic abdominal drainage tube placement after hepatobiliary surgery on postoperative infection. Randomized controlled trials on the placement of prophylactic abdominal drainage tube after hepatobiliary surgery were collected through a computerized search of PubMed, Embase, Conchrane Library and Web of Science databases, with a time range from the establishment of the database to August 2023. After two researchers independently screened the literature, extracted information, and evaluated the quality of the included studies. Finally, 13 studies were included, including 3620 patients, and the results showed that there was no statistically significant difference in postoperative infection rate between the drainage group (1840 patients and the non‐drainage group [1783 patients] [relative risk, RR = 1.17, 95% confidence interval, CI: 0.94–1.47, p = 0.16]. Compared with the drainage group, the incidence of infectious abdominal fluid in the non‐drainage group was lower (RR = 2.09, 95% CI: 1.57–2.80, p &lt; 0.00001), and the incidence of postoperative bile leakage was lower (RR = 1.77, 95% CI: 1.27–2.47, p &lt; 0.001) and shorter hospital stays after surgery (mean difference = 1.27, 95% CI: 0.32–2.22, p = 0.009). In conclusion, placing a prophylactic abdominal drainage tube after hepatobiliary surgery does not reduce postoperative infection rates compared with no drainage.

Impact of early postoperative haemodynamic and laboratory parameters on outcome after the Fontan procedure.

To identify early postoperative haemodynamic and laboratory parameters predicting outcomes following total cavopulmonary connection. Patients who underwent total cavopulmonary connection between 2012 and 2021 were evaluated. Serial values of mean pulmonary artery pressure, mean arterial pressure, peripheral oxygen saturation, and lactate levels were collected. The influence of these variables on morbidities was analyzed. Cut-off values were calculated using the receiver operating characteristic analysis. A total of 249 patients were included. All patients had previous bidirectional cavopulmonary shunt. Median age and weight at total cavopulmonary connection were 2.2 (1.8-2.7) years and 11.7 (10.7-13.4) kg, respectively. All patients were extubated in the ICU at a median of 3 (2-5) hours after ICU admission. Postoperative pulmonary artery pressure, around 12 hours after extubation, was significantly associated with chest tube drainage (p = 0.048), chylothorax (p = 0.021), ascites (p = 0.016), and adverse events (p = 0.028). Receiver operating characteristic analysis revealed a cut-off value of 13-15 mmHg for chest tube drainage and chylothorax and 17 mmHg for ascites and adverse events. Mean arterial pressure 1 hour after extubation was associated with prolonged chest tube drainage (p = 0.015) and adverse events (p = 0.008). Peripheral oxygen saturation 6 hours after extubation (p = 0.003) was associated with chest tube duration and peripheral oxygen saturation 1 hour after extubation (p < 0.001) was associated with ascites. Lactate levels on 2nd postoperative day (p = 0.022) were associated with ascites and lactate levels on 1st postoperative day (p = 0.009) were associated with adverse events. Higher pulmonary artery pressure, lower mean arterial pressure, lower peripheral oxygen saturation, and higher lactate in early postoperative period, around 12 hours after extubation, predicted in-hospital and post-discharge adverse events following total cavopulmonary connection.

Efficacy and safety of intercostal nerve anastomosis in immediate subpectoral prosthetic breast reconstruction after nipple-areola-sparing mastectomy: a randomized, controlled, open-label clinical study.

This aims to investigate the efficacy and safety of intercostal nerve anastomosis among breast cancer patients who undergo immediate subpectoral prosthetic breast reconstruction after nipple-areola-sparing mastectomy. From 2022 to 2023, female patients between the ages of 20 and 60 diagnosed with stage I-IIIA breast cancer, who required and were willing to undergo immediate subpectoral prosthetic breast reconstruction after nipple-areola-sparing mastectomy, were screened and assigned to take the operation with (treatment group) or without (control group) intercostal nerve anastomosis (the nerves with appropriate length and thickness were selected from the 2nd-4th intercostal nerves, which were then dissociated and anastomosed to the posterior areola tissue). A radial incision at the surface projection of the tumor location was used. The patients' breast local sensation was assessed using Semmes-Weinstein monofilaments before the operation as well as at 10 days, 3 months, and 6 months postoperatively. Furthermore, the patients' quality of life was evaluated 6 months postoperatively using the EORTC QLQ-C30 questionnaire. Adverse events, operation duration, drainage volume, and the duration of drainage tube carrying time were also monitored and recorded. Compared to the pre-operative period, a significant decrease in local sensation was observed 10 days after surgery in both groups. However, the control group showed a significant reduction in sensation at 3 and 6 months postoperatively, while the treatment group showed noticeable recovery. A statistically significant difference (P < 0.001) in local sensation between the pre-operative and post-operative periods was observed at the final follow-up in the two groups. By the time of 3 and 6 months postoperatively, a significant difference was seen in the local sensation between the two groups. Intercostal nerve anastomosis was found to significantly improve the patients' quality of life, including emotional (P = 0.01), physical (P = 0.04), and social functioning (P = 0.02) and pain (P = 0.04). There were no significant differences in general characteristics (such as age, BMI, and subtypes). Although intercostal nerve anastomosis increased the duration of operation by around 20min (P < 0.001), it did not affect the volume or duration of postoperative drainage tube usage between the two groups. This study indicated that intercostal nerve anastomosis improved the local sensation and quality of life of patients who underwent immediate subpectoral prosthetic breast reconstruction after nipple-areola-sparing mastectomy. https://www.chictr.org.cn/showproj.html?proj=42487, identifier ChiCTR1900026340.

A noninvasive treatment for gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy.

Our objective was to assess the safety and efficacy of 3 tubes with or without covered esophageal stent placement for the management of gastro-mediastinal or gastro-pleural fistula. We retrospectively assessed the clinical data of 31 consecutive patients with gastro-mediastinal or gastro-pleural fistula treated by using a noninvasive treatment from February 2013 to July 2022. Patients received 3 tubes (jejunal feeding tube, gastrointestinal drainage tube and abscess drainage tube) with or without esophageal-covered stent placement. All patients received continue abscess drainage and nutritional support after procedure. The tubes and/or esophageal-covered stents were removed after fistula healing. All patients received 3 tubes placement and 11 patients with luminal narrowing received esophageal covered stent placement. Technically success was found in all patients, with no procedure-related death, esophageal rupture or massive hemorrhage. Abscess cavity disappeared in 22 patients, with a clinical success rate of 71.0%. All patients received esophageal stent placement were cured and stents were removed, for a median duration of 1.6 months (interquartile ranges [IQR] 1.4, 3.7). Three patients showed clinical improved, with markedly decreased abscess cavity and markedly shrunk fistula. The median survival was 30.8 months. The 1-, 3-, 5-year survival rates were 71.1%, 46.1% and 39.5%, respectively. A noninvasive treatment of 3 tubes with or without covered esophageal stent placement is safe and effective for gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy.

Optimisation of reduction for prolapsed silicone tube after lacrimal intubation.

A common complication of bicanalicular intubation is dislocation of the silicone tube. Eleven patients with prolapsed silicone tubes who had undergone bicanalicular nasal intubation were injected with a 2 per cent lidocaine solution to infiltrate the lacrimal duct mucosa. A memory wire probe was used to pull a 4-0 suture through the lacrimal passage retrogradely, allowing the suture to grab the silicone tube. Paraffin oil was applied to the contact part of the rope and the silicone tube, then the distal end of the silk thread was removed from the nostril until the tube was pulled into place. The prolapsed silicone tubes were restored by surgery in nine patients, with the drainage tube in the correct position in the eye and the lacrimal duct irrigation unobstructed. The optimisations made in this study are considered effective adjustments of reduction surgery for a prolapsed silicone tube.

An investigation on causes of delayed referral of patients with pleural empyema

Background: In the treatment of pleural empyema, medical therapy is typically sufficient for the 1st or 2nd stage. However, surgical intervention becomes the optimal modality in the 3rd stage. A significant number of patients experience delayed diagnosis and treatment, leading to the conversion of non-surgical pleural empyema into complicated surgical empyema&#x0D; Methods: A cross-sectional study was conducted on patients with pleural empyema who were admitted to NRITLD in Tehran from 2015 to 2016. Initially, 66 patients were selected; however, after the exclusion of 12 patients, a total of 54 patients were included in the study&#x0D; Results: Delays were attributed to the medical system in 62% of cases and to the patient in 29% of cases. The median (IQR) of the total delay time attributed to the system was 38 (25) days. No significant difference was found in the median of delayed referrals between genders. A significant correlation was observed between the interval of the first and last visit and the interval between the onset of symptoms and chest x-ray (CXR), as well as the interval between the performance of CXR and the insertion of chest tube drainage (CTD).&#x0D; Conclusions: The delay in referral and treatment can be attributed to the patient, practitioners, or both. In this study, it was found that the medical system is the primary cause of delay, primarily due to the long waiting times for admission and operation in hospitals. Patients who experience a delay in CXR and CTD insertion will face a significant delay in referral and their course of treatment. It is suggested that delayed referral could be prevented by providing patients with basic medical education, offering specialized training to general practitioners for early referral, and managing waiting lists effectively.

Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients.

Platelets (PLTS) and fresh frozen plasma (FFP) are often transfused in cardiac surgery patients for perioperative bleeding. Their relative effectiveness is unknown. We conducted an entropy-weighted retrospective cohort study using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database. All adults undergoing cardiac surgery between 2005-2021 across 58 sites were included. The primary outcome was operative mortality. Of 174,796 eligible patients, 15,360 (8.79%) received PLTS in the absence of FFP and 6,189 (3.54%) patients received FFP in the absence of PLTS. The median cumulative dose was 1 unit of pooled platelets (IQR 1 to 3) and 2 units of FFP (IQR 0 to 4) respectively. After entropy weighting to achieve balanced cohorts, FFP was associated with increased perioperative (Risk Ratio [RR], 1.63; 95% Confidence Interval [CI], 1.40 to 1.91; P<0.001) and 1-year (RR, 1.50; 95% CI, 1.32 to 1.71; P<0.001) mortality. FFP was associated with increased rates of 4-hour chest drain tube output (Adjusted mean difference in ml, 28.37; 95% CI, 19.35 to 37.38; P<0.001), AKI (RR, 1.13; 95% CI, 1.01 to 1.27; P = 0.033) and readmission to ICU (RR, 1.24; 95% CI, 1.09 to 1.42; P = 0.001). In perioperative bleeding in cardiac surgery patient, platelets are associated with a relative mortality benefit over FFP. This information can be used by clinicians in their choice of procoagulant therapy in this setting.

Expert consensus on anesthesia in Enhanced Recovery after Surgery for esophageal cancer surgery

Esophageal cancer is one of the common malignant tumors of the digestive system in China. Surgical intervention is a frequently employed method for treating esophageal cancer. However, esophagectomy is a complex surgical procedure with a relatively high incidence of complications and mortality. In recent years, enhanced recovery after surgery (ERAS) as a novel medical concept, has gradually gained acceptance among healthcare professionals and been widely applied. It has also demonstrated significant efficacy in the surgical treatment of esophageal cancer. This article summarizes evidence-based medicine (EMB) in the perioperative period of ERAS for esophageal cancer treatment and formulates a clinical pathway for ERAS in esophageal cancer treatment throughout the perioperative period, aiming to provide guidance for clinical practice. Preoperatively, the following measures are advocated: preoperative education, preoperative nutrition assessment and risk assessment, individualized fasting and fluid restriction, optimal timing of surgery after neoadjuvant therapy, and the establishment of a multidisciplinary team (MDT) collaborative diagnostic and treatment model. Intraoperatively, optimization of anesthesia strategies, maintenance of optimal fluid balance, implementation of protective lung ventilation strategies, prevention of intraoperative hypothermia, and the selection of appropriate surgical techniques are essential. Postoperatively, effective pain management, thrombosis prevention, early mobilization, early removal of nasogastric tubes, drainage tubes, and urinary catheters, prevention of postoperative complications, and proactive enteral nutrition should be emphasized. It is important to note that the ERAS protocol is not static and continues to undergo improvement, with ongoing systematic training and promotion in the hope of wider adoption in more medical centers.

Early tirofiban versus heparin for bridging dual antiplatelet therapy in patients undergoing coronary endarterectomy combined with coronary artery bypass grafting: a multicenter randomized controlled trial protocol (the THACE-CABG trial)

BackgroundFor complete revascularization, patients with diffuse coronary artery disease should have a coronary endarterectomy and a coronary artery bypass graft (CE-CABG). Sadly, CE can lead to a lack of endothelium, which raises the risk of thrombotic events. Even though daily dual antiplatelet therapies (DAPT) have been shown to reduce thrombotic events, the risk of perioperative thrombotic events is high during the high-risk period after CE-CABG, and there is no consistent protocol to bridge DAPT. This trial aims to compare safety and efficacy between tirofiban and heparin as DAPT bridging strategies after CE-CABG.MethodsIn phase I, 266 patients undergoing CE-CABG will be randomly assigned to tirofiban and heparin treatment groups to compare the two treatments in terms of the primary safety endpoint, chest tube drainage in the first 24 h. If the phase I trial shows tirofiban non-inferiority, phase II will commence, in which an additional 464 patients will be randomly assigned. All 730 patients will be studied to compare major cardiovascular and cerebrovascular events (MACCEs) between the groups in the first 30 days after surgery.DiscussionGiven the possible benefits of tirofiban administration after CE-CABG, this trial has the potential to advance the field of adult coronary heart surgery.Trial registrationchictr.org.cn, ChiCTR2200055697. Registered 6 January 2022. https://www.chictr.org.cn/com/25/showproj.aspx?proj=149451. Current version: 20,220,620.

Standard versus mini amplatz size in patients undergoing pediatric percutaneous nephrolithotomy through 16 years of experience: A retrospective study in single-center experience

Background: Pediatric urolithiasis is associated with considerable morbidity and a very high recurrence rate of approximately 67%. Current guideline recommendations for standard pediatric percutaneous nephrolithotomy (PCNL) remain a problem due to several complications, such as hemorrhage or renal damage, especially in the pediatric population. However, mini-PCNL is regarded as a safer and more effective method for pediatric patients. This study compares PCNL with mini-PCNL, along with their efficacy and safety, in the Cipto Mangunkusumo General Hospital, Indonesia. Methods: This observational retrospective study was performed on pediatric patients aged &lt; 18 years (pediatric patients) who underwent PCNL with a standard 22-30 Fr sheath or mini 15-21 Fr sheath. We reviewed postoperative outcomes, including stone-free rate (SFR), presence of complications, and postoperative drainage method. Data analysis was performed using SPSS version 26.0. Results: Our study included a total of 42 pediatric patients (mean age: standard, 4.61 ± 3.52 years; mini, 8.0 ± 3.57 years; p&lt;0.05). The stone-free rate was significantly higher in the mini-PCNL group (87.9%) than in the standard PCNL group (59.1%, p &lt;0.05). All patients treated with mini-PCNL were tubeless, while some patients in the standard group still needed a postoperative drainage tube (p=0.012). Complications, such as infundibulum laceration, were rare, and their differences between groups insignificant (p=1). Even though it has been demonstrated that standard sheath PCNL is considered effective for children, smaller PCNL sheaths offers more experience. Mini-PCNL provides a similar complication rate, while remaining effective in treating urolithiasis; thus, it is thought to be a non-inferior option for treating pediatric populations, especially younger and smaller children. Conclusions: Mini-PCNL is non-inferior to standard PCNL in terms of efficacy and safety for the treatment of pediatric urolithiasis. Mini-PCNL resulted in higher SFR and totally tubeless follow-up.