Thoracotomy In Patients Research Articles

Analysis of contributing factors and nursing interventions for postoperative agitation following general anesthesia in thoracotomy patients.

To analyze the factors influencing agitation during emergence from general anesthesia in patients undergoing thoracotomy and to explore corresponding nursing interventions to optimize the postoperative recovery process. This study included 200 patients who underwent thoracotomy with general anesthesia at our hospital between January 12, 2022, and June 1, 2023. After surgery, all patients were closely monitored in the Intensive Care Unit (ICU). Based on their agitation status during emergence from anesthesia, patients were divided into 2 groups: an observation group (87 cases with agitation) and a control group (113 cases without agitation). We performed univariate analysis and multivariate logistic regression to identify risk factors for agitation. Based on these findings, we proposed targeted nursing strategies to address the causes of agitation, prevent complications, and meet patient care needs. Univariate analysis showed significant differences between the observation and control groups regarding age, propofol dosage, duration of surgery, infusion volume, and preoperative cognitive dysfunction (P < .05). Multivariate logistic regression identified 3 key risk factors: age over 60 years, surgery duration over 2 hours, and preoperative cognitive dysfunction. Based on these findings, we developed targeted nursing strategies to reduce the incidence of agitation and promote smooth recovery. Agitation during emergence from general anesthesia in patients undergoing thoracotomy is closely related to factors such as age and surgery duration. Developing personalized nursing plans based on these factors can enhance postoperative monitoring and care, thereby reducing agitation and improving recovery quality.

Advanced statistical approaches for predicting pain after pediatric thoracotomy: a cross-sectional study using zero-inflated and Poisson models

BackgroundThoracotomy is one of the surgical procedures most burdened by chronic post-operative pain. There is poor evidence regarding the possibility that even in pediatric patients, thoracotomy can be followed by post-operative pain. The primary objective of this analysis is to identify associations with home pain therapy, pain intensity, and possible protective factors acting on chronic pain in this population.MethodsA retrospective cross-sectional study was conducted at Ospedale Pediatrico Bambino Gesù IRCCS. The study included pediatric patients undergoing thoracotomy. For statistical analyses, a logistic model and a zero-inflated strategy were implemented to explore associations and predict factors related to home-based analgesic therapy and pain intensity.ResultsGender and age were identified as significant factors in the assignment of home therapy, with males having over seven times the risk compared to females (OR = 7.06, 95% CI = [2.11, 29.7]). At the last measurement, pain intensity was positively associated with age and the number of pain events during the week.ConclusionsThe study highlights significant factors influencing post-thoracotomy pain management in pediatric patients. These findings underscore the importance of tailored pain management strategies that consider gender and age to improve post-operative care and outcomes in pediatric thoracotomy patients.

Pain management after thoracotomy with dexamethasone and bupivacaine through a peripleural cather: a randomized controlled trial

IntroductionThoracotomy procedures can result in significant pain and cause nausea/vomiting. Glucocorticoids have anti-emetic and analgesic effects due to their anti-inflammatory and nerve-blocking properties. This study investigates the additive effect of local dexamethasone with bupivacaine as sole analgesic medication through a peripleural catheter after thoracotomy.MethodThe study was conducted as a randomized control trial on 82 patients. Participants were allocated to receive either 2.5 mg/kg of bupivacaine plus 0.2 mg/kg of dexamethasone or 2.5 mg/kg of bupivacaine plus the same amount of normal saline as placebo through a 6 French peripleural catheter implemented above the parietal pleura and beneath the musculoskeletal structure of the chest wall. The primary outcome was the severity of pain 24 h after the operation in the visual analogue scale (VAS) score. Secondary outcomes were the incidence of nausea/vomiting, opioid consumption for pain control, and incidence of any adverse effects.Results: A total of 50 participants were randomized to each group, and the baseline characteristics were similar between the groups. Median of VAS score (6 (3-8) vs. 8 (6-9), p < 0.001), postoperative opioid consumption (9 (36%) vs. 17 (68%) patients, p=0.024), and median length of hospital stay (4 (3-8) vs. 6 (3-12) days, p < 0.001) were significantly lower in the dexamethasone group. However, postoperative nausea/vomiting (p=0.26 for nausea and p=0.71 for vomiting) and surgical site infection (p = 0.55) were similar between the two groups. ConclusionIn thoracotomy patients, administering local dexamethasone + bupivacaine through a peripleural catheter can reduce postoperative pain, analgesic consumption, and length of hospital stay.Trial RegistrationIranian Registry of Clinical Trials (IRCT20220309054226N1, registration date: 3/21/2022.

Predictors of pulmonary metastases on chest computed tomography in children and adolescents with osteosarcoma—tips for qualifying patients for thoracotomy

BackgroundOsteosarcoma is the most common primary malignant bone tumour in children and adolescents. Lungs are the most frequent and often the only site of metastatic disease. The presence of pulmonary metastases is a significant unfavourable prognostic factor. Thoracotomy is strongly recommended in these patients, while computed tomography (CT) remains the gold imaging standard. The purpose of our study was to create tools for the CT-based qualification for thoracotomy in osteosarcoma patients in order to reduce the rate of useless thoracotomies.MethodsSixty-four osteosarcoma paediatric patients suspected of lung metastases on CT and their first-time thoracotomies (n = 100) were included in this retrospective analysis. All CT scans were analysed using a compartmental evaluation method based on the number and size of nodules. Calcification and location of lung lesions were also analysed. Inter-observer reliability between two experienced radiologists was assessed. The CT findings were then correlated with the histopathological results of thoracotomies. Various multivariate predictive models (logistic regression, classification tree and random forest) were built and predictors of lung metastases were identified.ResultsAll applied models proved that calcified nodules on the preoperative CT scan best predict the presence of pulmonary metastases. The rating of the operated lung on the preoperative CT scan, dependent on the number and size of nodules, and the total number of nodules on this scan were also found to be important predictors. All three models achieved a relatively high sensitivity (72–92%), positive predictive value (81–90%) and accuracy (74–79%). The positive predictive value of each model was higher than of the qualification for thoracotomy performed at the time of treatment. Inter-observer reliability was at least substantial for qualitative variables and excellent for quantitative variables.ConclusionsThe multivariate models built and tested in our study may be useful in the qualification of osteosarcoma patients for metastasectomy through thoracotomy and may contribute to reducing the rate of unnecessary invasive procedures in the future.

Erector spinae plane block reduces opioid consumption and improves incentive spirometry volume after cardiac surgery: A retrospective cohort study.

Effective postoperative pain management is vital in cardiac surgery to prevent opioid dependency and respiratory complications. Previous studies on the erector spinae plane (ESP) block have focused on single-shot applications or immediate postoperative outcomes. This study evaluates the efficacy of continuous ESP block vs conventional care in reducing opioid consumption and enhancing respiratory function recovery postcardiac surgery over 72 hours. A retrospective study at a tertiary hospital (January 2021-July 2022) included 262 elective cardiac surgery patients. Fifty-three received a preoperative ESP block, matched 1:1 with a control group (n = 53). The ESP group received 0.5% ropivacaine intraoperatively and 0.16% ropivacaine every 4 hours postoperatively. Outcomes measured were cumulative oral morphine equivalent (OME) dose within 72 hours postextubation, daily maximum numerical rating scale (NRS) ≥3, incentive spirometry volume, and %baseline performance, stratified by surgery type (sternotomy or thoracotomy). Significant OME reduction was observed in the ESP group (sternotomy: median decrease of 113 mg, 95% CI: 60-157.5 mg, p < 0.001; thoracotomy: 172.5 mg, 95% CI: 45-285 mg, p = 0.010). The ESP group also had a lower risk of daily maximum NRS ≥3 (adjusted OR sternotomy: 0.22, p < 0.001; thoracotomy: 0.07, p < 0.001), a higher incentive spirometry volumes (sternotomy: mean increase of 149 mL, p = 0.019; thoracotomy: 521 mL, p = 0.017), and enhanced spirometry %baseline (sternotomy: mean increase of 11.5%, p = 0.014; thoracotomy: 26.5%, p < 0.001). Continuous ESP block was associated with a reduction of postoperative opioid requirements, lower instances of pain scores ≥3, and improve incentive spirometry performance following cardiac surgery. These benefits appear particularly prominent in thoracotomy patients. Further prospective studies with larger sample size are required to validate these findings.

Comparison of Dexmedetomidine and Ketamine in Serratus Anterior Plane Block for Postoperative Pain Control in Thoracotomy Patients: A Randomized Clinical Trial.

Postoperative pain control after thoracotomy is very important, and if not controlled, it can cause severe complications. This study aimed to compare dexmedetomidine and ketamine in serratus anterior plane block (SAPB) in pain control after thoracotomy. This randomized clinical trial was conducted on 74 patients aged 18 to 60 years old with American Society of Anesthesiologists (ASA) class I or II who were referred to Imam Khomeini hospital in Ahvaz, Iran, for thoracotomy and randomly divided into two groups. After surgery, the SAPB with ultrasound-guided was performed. In the ropivacaine-ketamine (RK) group, ketamine 0.5 mg/kg and 0.4 cc/kg ropivacaine solution 0.25% and in the ropivacaine-dexmedetomidine (RD) group, in addition to 0.4 cc/kg ropivacaine 0.25%, dexmedetomidine 0.5 µg/kg was added. Verbal Numeric Scale (VNS), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), heart rate (HR), and mean arterial blood pressure (MAP) were recorded. There was no significant difference in both groups in terms of demographic information (P < 0.05). The average VNS was lower in the ketamine group than in the dexmedetomidine group; however, there was a significant difference only at 1, 12, and 24 hours after surgery (P < 0.05). There was no statistically significant difference between the two groups in terms of SBP and DBP, HR, and MAP. There was a significant difference in the RR in the two groups at 12 and 24 hours after the operation (P < 0.05). Dexmedetomidine and ketamine, which were used as supplements to ropivacaine for SAPB in patients undergoing elective thoracotomy, reduced the pain intensity after thoracotomy; nevertheless, the intensity of pain reduction was more and more effective in the group receiving ketamine.

Impact of cryoablation on operative outcomes in thoracotomy patients.

Cryoablation is increasingly being utilized as an alternative to epidurals for patients undergoing thoracotomies. Current evidence suggests cryoablation may decrease postoperative analgesia utilization, but could increase operative times. We hypothesized that the adoption of intraoperative cryoablation to manage post-thoracotomy pain would result in reduced length of stay and reduced perioperative analgesia compared to routine epidural use. A retrospective analysis was performed from a single, quaternary referral centre, prospective database on patients receiving thoracotomies between January 2020 and March 2022. Patients undergoing transthoracic hiatal hernia repair, lung resection or double-lung transplant were divided between epidural and cryoablation cohorts. Primary outcomes were length of stay, intraoperative procedure time, crossover pain management and oral narcotic usage the day before discharge. During the study period, 186 patients underwent a transthoracic hiatal hernia repair, lung resection or double-lung transplant with 94 receiving a preoperative epidural and 92 undergoing cryoablation. Subgroup analysis demonstrated no significant differences in demographics, operative length, length of stay or perioperative narcotic use. Notably, over a third of patients in each cryoablation subgroup received a postoperative epidural (45.5% transthoracic hiatal hernia repair, 38.5% lung resection and 45.0% double-lung transplant) for further pain management during their admission. Cryoablation use was not associated with an increase in procedure time, a decrease in narcotic use or length of stay. Surprisingly, many cryoablation patients received epidurals in the postoperative period for further pain control. Additional analysis is needed to fully understand the benefits and costs of epidural versus cryoablation strategies.

Thoracotomy Patients Under General Anesthesia: A Comparison on Intra-Operative Anesthetic and Analgesic Requirements, When Combined with Either Epidural Analgesia or Continuous Unilateral Paravertebral Analgesia.

Regional analgesia is effective for post-thoracotomy pain. The primary objective of the study is to compare the intraoperative requirement of isoflurane and fentanyl between general anaesthesia (GA) with epidural analgesia and GA with paravertebral analgesia. A prospective observational comparative study was conducted on 56 patients undergoing open thoracotomy procedures. The patients were divided into two groups of 28 by assigning the study participants alternatively to each group: Group GAE - received thoracic epidural catheterization with GA, and Group GAP - received ultrasound guided thoracic paravertebral catheterization on the operative side with GA. Intraoperative requirement of isoflurane, fentanyl, postoperative analgesia, stress response, need of rescue analgesics and adverse effects were observed and analysed. 25 patients in each group were included in the data analysis. The intraoperative requirement of isoflurane (32.28 ± 1.88 vs 48.31 ± 4.34 ml; p < 0.0001) and fentanyl (128.87 ± 25.12 vs 157 ± 30.92 μg; p = 0.0009) were significantly less in the GAE group than in the GAP group. VAS scores and need of rescue analgesics and blood glucose levels were not statistically significant during the postoperative period (p > 0.05). The incidence of adverse effects was comparable except for hypotension and urinary retention which were significantly higher in the GAE group. GA with epidural analgesia resulted in significant reduction in the intraoperative consumption of isoflurane and fentanyl in comparison to GA with paravertebral analgesia. However, both the techniques were equally effective in the postoperative period.

Lung Expansion Therapy for the Potential Populations: A Literature Review.

Secretion retention, atelectasis, and reduced lung compliance occur when endotracheal or tracheostomised patients cough ineffectively. There is a possibility of infection if the collapsed regions of the lungs are not reinflated. Therefore, to improve clinical outcomes, such as diaphragm mobility and thickness, lung volume, and thickness of the abdominal muscles, and decrease the length of hospitalizations, mechanical and manual techniques, such as balloon blowing exercises and incentive spirometer, are required. PubMed, Google Scholar, Pedro, Clinical Keys, Helinet, ProQuest, and Science Direct databases were used for the literature search considering the inclusion and exclusion criteria. The several manual and mechanical methods that were employed for lung expansion treatment for the potentialpopulations are highlighted in this overview of the literature. Ten studies were considered in this review: five on balloon-blowingexercises, four on tracheostomy with incentive spirometry exercises, and one on incentive spirometry with balloon-blowingexercises. The effects were examined on individual outcomes that included rate of perceived exertion (RPE), diaphragm mobility, pulmonary function, volume of breath, length of hospitalization, and postoperative day complications. The structured protocols proved to be effective in improving lung expansion and pulmonary function for the potential population that involved healthy adults, noncritical COVID-19 adults, smokers, thoracotomy patients, and tracheostomised patients. The road to recovery is yet unexplored and underachieved because of the lackof evidence.

Sternotomy or Thoracotomy: Which One?

Abstract: Penetrating injuries to the chest present a frequent and challenging problems. Median sternotomy and thoracotomy are two choices to explore any trauma to the chest. We report a 37-year-old man with wound and pain in his left chest due to being stabbed with a knife one hour ago. On physical examination, an open wound measured 5x1.5 cm as high as the third rib parallel to the left parasternal line, the edges of the wound bed were flattened by the periosteum. Laboratory examination showed leukocytosis. FAST showed an important left pleural effusion and pericardial fluid. CTA study showed the presence of air in the anterior mediastinum and the left pleural cavity. In the fifth intercostal space, a left anterolateral thoracotomy was performed and 800 ml of blood was evacuated from the left chest. The left lung was lowered to open the pericardium, which caused a further drop in blood pressure; then, the pericardium was opened and a blood clot (1500 ml) was removed. An epicardial wounds were found on the anterior surface of the right ventricle. The left anterior coronary artery was actively bleeding. The hemorrhagic lesion was stitched with 4.0 polypropylene reinforced with a Teflon strip. The patient recovered uneventfully on the sixth postoperative day. During the 14-month follow-up, the patient was fine and back to work. In conclusion, surgeon must be able to decide the technique of approach in the operating room considering the site of injury and the presence of involving organ. Thoracotomy patient can also receive median sternotomy if the cardiac injuries could not be repaired through thoracotomy. In addition, some patients with median sternotomy also received additional thoracotomy due to their pulmonary injuries. Keywords: penetrating injuries; thoracotomy; sternotomy; cardiac injury

Late Survival After Redo Mitral Operation With Minithoracotomy Compared With Sternotomy

BackgroundThe long-term effectiveness of minithoracotomy over redo median sternotomy for reoperative mitral operation is not well described. Here we present long-term survival after reoperative mitral operation based on operative approach. MethodsAdults undergoing mitral valve operation with previous sternotomy by redo sternotomy and minithoracotomy were reviewed from our prospectively maintained institutional database from 1997 to 2022. Propensity score matching was performed to compare short- and long-term outcomes. ResultsOf 750 consecutive patients, thoracotomy was performed in 503 (67%). Median follow-up was 5.0 years (interquartile range, 0-23 years). Intraoperatively, sternotomy patients were more likely to have central aortic cannulation (205 of 223 [93%] vs 265 of 481 [56%]), cardioplegic arrest (220 of 223 [99%] vs 124 of 481 [26%]), and mitral valve replacement (190 of 223 [85%] vs 358 of 481 [74%]). Thoracotomy patients were older (63 ± 13 vs 58 ± 14 years) with elective presentation (387 of 503 [77%] vs 128 of 247 [52%]). Sternotomy patients were more likely to have endocarditis (52 of 247 [21%] vs 45 of 503 [9%], P < .001). At 10 years, thoracotomy patients experienced improved survival (52% ± 3% vs 46% ± 4%, P = .004). After propensity matching, 10-year survival was significantly higher for thoracotomy patients compared with sternotomy patients (60% ± 5% vs 42% ± 5%, P = .0006). The greatest difference in survival was at the first 6 months after operation (96% ± 1% vs 81% ± 3%, P < .001). ConclusionsFor patients undergoing reoperative mitral valve operation, minimally invasive right anterior thoracotomy can significantly decrease risk of death in the first 6 months, with durable survival benefit out to 10 years. We present a large single-center series to suggest an important opportunity to durably improve outcomes after reoperative mitral operation through wider use of right minithoracotomy.

Assessment of complications and surgical timing in post-COVID-19 thoracotomy patients: A single-center experience

Background: This study aims to assess the complications in post-novel coronavirus disease 2019 (COVID-19) thoracotomy patients and to evaluate the time interval between infection and surgery and the effect of vaccine timing and vaccine type in these patients. Methods: Between May 2020 and January 2022, a total of 74 patients (34 males, 40 females; mean age: 54.5±13.7 years; range, 22 to 27 years) who had COVID-19 infection and underwent thoracic surgery were retrospectively analyzed. Data including demographic and clinical characteristics, the surgery type, length of intensive care unit and hospital stay, and postoperative complications were recorded. Complications were defined as respiratory, cardiac, thrombotic, and other complications. The time period between COVID-19 infection and surgery was noted. All patients were questioned regarding their vaccination status. Results: Having a symptomatic COVID-19 infection did not significantly affect the development of postoperative complications and length of intensive care unit or hospital stay. Thoracic involvement was the main factor which affected the length of intensive care unit and hospital stay during COVID-19 infection (p=0.004 and p=0.003, respectively). Conclusion: Our study results suggest that the length of hospital and intensive care unit stay is related to the time period between infection and surgery. The longer that the patient waits after COVID-19 infection, the less time that the patient stays in the hospital.

Serratus anterior plane block versus thoracic epidural block in patients undergoing thoracotomy: a randomized double-blind trial

Background &amp; Objective: Standard pain management technique after thoracic surgery is thoracic epidural analgesia, parentral analgesics and nerve blocks. Thoracic epidural analgesia (TEA) has many known complications, including respiratory depression and urinary retention. Serratus anterior plane block (SAPB) is a simple procedure, which provides postoperative pain relief by blocking the lateral cutaneous branches of T2–T9 spinal neurons. We compared the analgesic efficacy of both of these techniques in thoracotomy patients in this randomized trial.&#x0D; Methodology: The study involved 74 cancer patients scheduled for thoracotomy. The patients were randomly divided into two groups. The patients in Group SAPB underwent ultrasound-guided serratus anterior plan block (SAPB) with catheter insertion. The second group (Group TEA) underwent TEA with preoperative indwelling catheter insertion. In both groups blocks were activated before induction of routine general anesthesia (GA) by a bupivacaine bolus dose, then continued as bupivacaine infusion in ICU for postoperative analgesia. Hemodynamic monitoring was started. Intraoperative fentanyl consumption, postoperative morphine consumption, and time to first request for analgesic were noted including MAP in the two groups.&#x0D; Results: Both groups were statistically comparable regarding intraoperative fentanyl consumption, postoperative morphine consumption, and time to first request for analgesia in the two groups. Hypotensive episodes were significantly more frequent (P &lt; 0.001) in the TEA group (n = 17; 45.9%) compared to the Group SAPB (n = 2; 5.4%). Ramsey sedation scores (RSS) were comparable in the two groups immediately postoperatively and after 2 h. After 4 h after recovery all patients in both groups had an RSS of 2.&#x0D; Conclusion: Ultrasound-guided serratus anterior plane block is associated with reduced intraoperative and postoperative fentanyl consumption, but the Ramsey sedation scores were equivalent in the two groups after recovery and upto 4h.&#x0D; Abbreviations: GA: General Anesthesia; PTPS: Post-Thoracotomy Pain Syndrome: RSS: Ramsey Sedation Score; SAPB: Serratus Anterior Plane Block; TEA: Thoracic Epidural Analgesia; VATS: Video-Assisted Thoracoscopic Surgery&#x0D; Key words: Pain, Postoperative; Serrataus plane block; Thoracotomy; Ultrasound; Thoracic epidural&#x0D; Citation: Gamal RM, Bossily SS, Ali AR, Samy SF, Seif NE, Ahmed HI. Serratus anterior plane block versus thoracic epidural block in patients undergoing thoracotomy: a randomized double-blind trial. Anaesth. pain intensive care 2023;27(3):389−395.&#x0D; DOI: 10.35975/apic.v27i3.2243&#x0D; Received: March 06, 2023; Reviewed: March 31, 2023; Accepted: April 01, 2023

Comparison of analgesic efficacy of different local anesthetic volumes for erector spinae plane block in thoracotomy patients; a prospective randomized trial

BackgroundErector spinae plane block (ESPB) is a thoracic wall block that has been used frequently in recent years. It was aimed to compare the analgesic efficacy of bupivacaine in different volumes for ESPB in patients undergoing thoracotomy.MethodsPatients who were in the age range of 18 to 65 years, ASA I–III, had a body mass index (BMI) of 18–30 kg/m2 and were undergoing thoracotomy were included in the study. Patients were assigned to ESPB with 30 ml 0.25% bupivacaine (Group-1) or ESPB with 20 ml 0.25% bupivacaine (Group-2) groups according to the analgesia protocol. In the postoperative care unit, intravenous morphine was administered via a patient-controlled analgesia pump for 24 h. A paracetamol dose of 1 g every 8 h and a dexketoprofen dose of 50 mg twice daily were administered iv for multimodal analgesia.ResultsVisual analog scale (VAS) resting scores, the 1st (p = 0.001), 2nd (< 0.001), 4th (< 0.001), 8th (< 0.001), 16th (< 0.010), 24th (< 0.044), and 48th (< 0.005)-hour VAS resting results were found to be statistically significantly higher in the 20 ml group than the 30 ml group. VAS cough scores were statistically significantly higher in the 20 ml group at the 1st (< 0.003), 2nd (< 0.001), 4th (< 0.001), 8th (< 0.001), 16th (< 0.004), 24th (< 0.031), and 48th (< 0.009)-hour. Morphine consumption, and additional analgesic use were found to be statistically significantly higher in the 20 ml group than in the 30 ml group (p < 0.001, p = 0.001, respectively). There was no statistically significant difference between the groups in terms of side effects (p > 0.05).ConclusionsThe results of ESPB applied with 20 ml and 30 ml of local anesthetic before the surgical incision in thoracotomy patients showed that the use of 30 ml of local anesthetic provided more effective analgesia. In addition, similar side-effect rates show that 30 ml of local anesthetic can be used safely.

Incidence and risk factors of ipsilateral shoulder pain in patients after thoracic surgeries.

Ipsilateral shoulder pain (ISP) post-thoracotomy impairs the recovery in early postoperative period, the aetiology of which is unclear. We studied to find out the incidence and risk factors associated with ISP. We did a prospective observational study, wherein 296 patients scheduled for thoracic surgeries were enroled. Pain in the shoulder during activity was assessed using American Shoulder and Elbow Surgeons standardised assessment method. All potential predictors were analysed in a multivariable penalised logistic regression model, using ISP as the outcome variable. Of the 296 patients, 118 (39.8%) patients developed ISP. Of the 296 patients, 170 patients underwent thoracotomy and 110 underwent video-assisted thoracoscopic surgeries. The incidence of ISP was higher in thoracotomy patients (45.29%) compared to video-assisted thoracoscopic surgeries (32.7%). Majority of patients (43.2%) were aged more than 65 years, which was statistically significant as per univariate analysis (P = .007). The incidence of ISP was the highest at 41.89% among those who had lung cancer (n = 74), with disease involving right upper lobe and left upper lobe, 29% and 25.8%, respectively. The pain severity was moderate in 27.1% of patients during shoulder movements. Among the patients who had ISP, 77.1% expressed it as dull aching, whereas 21.2% described it as stabbing in nature. The incidence of ISP in those who underwent thoracic surgery was high and dull aching in nature, of mild to moderate intensity, commonly located on the posterior aspect of the shoulder. It was more common in those who underwent thoracotomy and more than 65 years of age.

Minimally invasive sleeve lobectomy for centrally located lung cancer: A real-world study with propensity-score matching.

The safety, feasibility, and prognosis of sleeve lobectomy by minimally invasive surgery (MIS) remain to be validated. The purpose of this study was to investigate outcomes in real-world patients receiving minimally invasive sleeve lobectomy in a balanced large cohort. Between January 2013 and December 2018, 578 consecutive patients undergoing sleeve resection at a high-volume center were retrospectively analyzed. Surgical and oncologic outcomes were compared between MIS and thoracotomy patients after propensity-score matching (PSM). MIS sleeve lobectomy was increasingly used as a time-trend in real-world. Before PSM, the MIS group had smaller tumor size, more T2-stage cases, and more right upper lobe sleeve lobectomies compared to the Open group. After 1:4 PSM by patient demographics and tumoral characteristics, 100 cases of MIS and 338 cases of Open sleeve lobectomy were further analyzed. Although median operation time was longer in the MIS group than in the Open group (170.5 minutes vs.149.5 minutes, P < 0.001), patients in MIS group had significantly less estimated intraoperative blood loss (100 ml vs. 200 ml, P = 0.003), shorter drainage duration (5 days vs. 6 days, P = 0.027) and less amount of drainage (1280 ml vs. 1640 ml, P < 0.001) after surgery. Complete resection rate, combined angioplasty, number of dissected lymph nodes, post-operative length of stay, postoperative morbidity and mortality rate, and application of adjuvant therapy were similar between the two matched groups. Conversion to open thoracotomy was necessary in 13.6% patients, but with similar perioperative outcomes compared to Open cases except for longer operation time. More lower lobe sleeve lobectomies were accomplished via robot-assisted thoracoscopic surgery than via video-assisted thoracoscopic surgery (40.0% vs. 12.0%, P = 0.017) in MIS patients. Five-year overall survivals (MIS vs. Open: 72.7% vs. 64.4%, P = 0.156) and five-year progression-free survivals (MIS vs. Open: 49.2% vs. 50.5%, P = 0.605) were similar between the two matched groups. MIS sleeve lobectomy is associated with similar or even better perioperative results and oncologic outcomes to open thoracotomy. Conversion to thoracotomy does not compromise perioperative outcomes. Robot surgery may be preferable for more complex sleeve resections.

Liver dome hydatid cyst surgery: Laparotomy or thoracotomy?

The liver is the most common organ of the body that is at risk of getting affected by hydatid cyst (75%). All lobes of the liver can be involved with the formation of hydatid cyst, but the right lobe is more involved than the left lobe. The rate of involvement of liver dome and segments 7 and 8 of the right lobe has not been reported so far, but the best treatment for liver hydatid cyst has been found to be surgery. In this study, 240 patients with liver hydatid cyst underwent surgery from 2005 to 2017. In this retrospective study, the variables of gender, age, number of liver cysts, involvement of lobe and segments, simultaneous involvement of liver and lung, laparotomy, thoracotomy, the number of patients referred due to the lack of finding cysts in laparotomy, and surgical complications were analyzed. The results showed that the majority of patients were males with age ranging from 8 to 68 years. Right lobe involvement was observed in most of the patients. About 62 patients showed involvement of liver dome and segments 7 and 8. Therefore, 62 patients underwent thoracotomy according to the criteria introduced and the rest of the patients (n = 178) underwent laparotomy. The results showed that there was a potential for capitonnage in 46 patients in thoracotomy. The pain score was 4-5 according to the VAS criterion. The rate of using analgesic drug did not show significant difference between the two methods. During the manipulation, cysts might be ruptured and give rise to complications such as spread of the disease, shock, and anaphylaxis, which may be followed by legal complaints. Therefore, in order to perform the surgery successfully, a new method along with computed tomography (CT) scan has been introduced in this study, which can be very helpful.

Enhanced recovery after chest wall resection and reconstruction: a clinical practice review.

Since the late 1990s, and Henrik Kehlet's hypothesis that a reduction of the body's stress response to major surgeries could decrease postoperative morbidity, "Enhanced Recovery After Surgery" (ERAS) care pathways have been streamlined. They are now well accepted and considered standard in many surgical disciplines. Yet, to this day, there is no specific ERAS protocol for chest wall resections (CWRs), the removal of a full-thickness portion of the chest wall, including muscle, bone and possibly skin. This is most unfortunate because these are high-risk surgeries, which carry high morbidity rates. In this review, we propose an overview of the current key elements of the ERAS guidelines for thoracic surgery that might apply to CWRs. A successful ERAS pathway for CWR patients would entail, as is the standard approach, three parts: pre-, peri- and postoperative elements. Preoperative items would include specific information, targeted patient education, involvement of all members of the team, including the plastic surgeons, smoking cessation, dedicated nutrition and carbohydrate loading. Perioperative items would likely be standard for thoracotomy patients, namely carefully selective pre-anesthesia sedative medication only in some rare instances, low-molecular-weight heparin throughout, antibiotic prophylaxis, minimization of postoperative nausea and vomiting, avoidance of fluid overload and of urinary drainage. Postoperative elements would include early mobilization and feeding, swift discontinuation of intravenous fluid supply and chest tube removal as soon as safe. Optimal pain management throughout also appears to be critical to minimize the risk of respiratory complications. Together, all these items are achievable and may hold the key to successful introduction of ERAS pathways to the benefit of CWR patients.

National analysis of whole blood and component versus component transfusions in civilian trauma patients who underwent a thoracotomy or laparotomy: Toward improving patient outcomes and quality of care

BackgroundThis study aimed to investigate the associations of whole blood and component versus component transfusions with in-hospital mortality, complication rates, intensive care unit length of stay, and packed red blood cells transfusion volumes in adult civilian trauma patients. MethodsWe performed a retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File 2016 to 2019 dataset. Adult civilian trauma patients (aged >18 years) sustaining injuries of at least moderate severity who received whole blood and component or component within 4 hours of arrival and underwent thoracotomy or laparotomy were included. Multivariable regression analysis was used to compare outcomes between whole blood and component and component groups. ResultsA total of 37,384 patients met eligibility criteria, of which 218 received whole blood and component and 37,166 received component. There was no significant difference in in-hospital mortality between whole blood and component and component groups for those who underwent thoracotomy (adjusted odds ratio = 0.408, P = .413) or laparotomy (adjusted odds ratio = 1.046, P = .857). Thoracotomy patients who received whole blood and component had no difference in 4-hour or 24-hour pack red blood cell volumes (3336 mL vs 3106 mL, P = .754; 3 658mL vs 3,636mL, P = .982), intensive care unit length of stay (10.68 days vs 8.63 days, P = .542), or complications rates compared to those who received component. Laparotomy patients who received whole blood and component had no difference in 4 hour or 24-hour packed red blood cell volumes (2,758 mL vs 2,721mL, P = .927; 3,538 mL vs 3,385 mL, P = .754), intensive care unit length of stay (11.78 days vs 9.90 days, P = .177), or complications rates compared to those who received component. ConclusionStudy findings have indicated that a combined resuscitation with whole blood and component transfusion in adult civilian trauma patients is a viable alternative to component transfusion alone.

Comparison of efficacy and safety of hybrid video-assisted thoracoscopic surgery vs. thoracotomy sleeve lobectomy for non-small cell lung cancer: a propensity score matching study.

BackgroundIt is unclear whether hybrid video-assisted thoracoscopic surgery (VATS) sleeve lobectomy (SL) could be an alternative to thoracotomy SL for non-small cell lung cancer (NSCLC) treatment. The aim of the study is to investigate the safety and efficacy of hybrid VATS SL.MethodsWe collected 112 patients who received hybrid VATS SL or thoracotomy SL for primary treatment of NSCLC at Liaoning Cancer Hospital & Institute from November 2016 to September 2021. Perioperative and survival data were collected, and retrospective analysis was conducted on 91 thoracotomy and 21 hybrid VATS SL patients to evaluate the safety and efficacy of two approaches. Propensity score matching (PSM) was used to minimize selection bias. The Kaplan-Meier method was applied to compare overall survival (OS) and recurrence-free survival (RFS). Follow-up data were obtained by outpatient clinical visit and nurse-led telephone.ResultsA total of 112 patients were included in this study, including thoracotomy patients (n=91) and hybrid VATS patients (n=21). In the non-match analysis, the baseline data of patients was similar between the two groups, except regarding the receipt of neoadjuvant therapy (P=0.087). After PSM (2:1), a total of 39 thoracotomy patients and 19 hybrid VATS patients were enrolled. The baseline variables were quite similar in both groups. In the hybrid group, the number of lymph nodes (25.9±8.5 vs. 32.9±9.7, P<0.01) and positive lymph nodes (3.7±2.9 vs. 5.6±4.0, P=0.045) were significantly higher than those in the thoracotomy group. The hybrid group was associated with significantly shorter postoperative hospital stay (9.5±3.5 vs. 7.3±2.9, P=0.021) and chest tube duration time (6.6±3.1 vs. 5.3±1.5, P=0.031). No statistical difference in complications, reoperation, and recurrence were observed between the hybrid VATS SL and thoracotomy SL (P=1.0, P=1.0, P=0.472). The 30- and 90-day mortalities showed no differences between approaches (2.6% vs. 0%, P=1.0; 5.1% vs. 5.3%, P=1.0). No significant differences were found between thoracotomy and hybrid VATS SL in 3-year OS (P=0.614) and 3-year RFS (P=0.750).ConclusionsHybrid VATS SL lobectomy may be a safe and feasible approach associated with similar oncologic prognosis and better postoperative recovery compared with thoracotomy SL for NSCLC treatment.