Postoperative Chest Drainage Research Articles

Right anterior thoracotomy vs. upper hemisternotomy for aortic valve replacement with Perceval S: is there a difference?

BackgroundOur study aimed to evaluate the early outcomes of aortic valve replacement with Perceval S sutureless valve through the right anterior thoracotomy and upper hemisternotomy approaches, and to determine if there are any differences between these two approaches.MethodsWe carried out a study using data from 174 patients who underwent minimally invasive Perceval S valve implantation for aortic valve stenosis between January 2018 and August 2023. This was a retrospective, single-center observational study. The patients were divided into two groups: the hemisternotomy group (n = 100) and the right anterior thoracotomy group (n = 74).ResultsThe overall in-hospital mortality was 1,7%. The cardiopulmonary bypass and cross-clamp times were longer in the right anterior thoracotomy group (p < .001). There were no statistically significant differences in terms of stroke, paravalvular leak, mechanical ventilation time, blood transfusion requirements, pacemaker implantation, reexploration for bleeding, conversion, wound infection, or in-hospital stay. Postoperative chest drainage was lower (p < .001) and postoperative atrial fibrillation occurred less frequently (p = .044) in the right anterior thoracotomy group. The median intensive care unit stay was shorter in the right anterior thoracotomy group (p = .018).ConclusionAortic valve replacement with the Perceval S valve through either an upper hemisternotomy or a right anterior thoracotomy is a procedure associated with low perioperative complication rates. Right anterior thoracotomy for an aortic valve replacement with the Perceval S valve was associated with lower postoperative bleeding, a lower postoperative atrial fibrillation incidence and a shorter intensive care unit stay compared to upper hemistornotomy.

A Clinical Study on the Treatment of Adult Atrial Septal Defect Using Thoracoscopic-Assisted Right Vertical Infra-Axillary Thoracotomy, Total Thoracoscopic, and Median Sternotomy Approaches

Background: To compare the clinical outcomes of three surgical approaches for treating adult atrial septal defects (ASD): Thoracoscopic-assisted right vertical infra-axillary thoracotomy (TARVIAT) under central cardiopulmonary bypass (CPB), totally thoracoscopic (TT), and median sternotomy (MS) approaches, and to assess the feasibility and safety of the TARIAVT approach. Methods: This study reviewed 62 cases patients of repairing atrial septal defects via a TARVIAT and central extracorporeal circulation from 2019 to 2023. The patients included 22 males, aged between 18 and 59 years, with a mean age of 33.35 ± 10.97 years. The surgical indications were adult patients with moderate to severe tricuspid regurgitation and who were unsuitable for interventional closure of atrial septal defects. Exclusion criteria included patients diagnosed with severe pulmonary hypertension or Eisenmenger syndrome. Additionally, 67 patients who underwent TT approach repair of ASD and 72 patients who underwent MS approach repair of ASD were selected as the control groups. Operative time, CPB time, aortic clamping time, postoperative Intensive care unit (ICU) stay, postoperative mechanical ventilation time, 24-hour postoperative chest drainage, incision length, postoperative hospital stay, hospital costs, and postoperative complications were compared to assess statistical differences. Results: There were no deaths or major complications observed in any of the three groups. Statistically significant differences were found among the three groups in terms of extracorporeal circulation time, aortic clamping time, surgical time, 24-hour postoperative chest drainage, postoperative mechanical ventilation time, postoperative ICU stay, incision length, and postoperative hospital stay (p < 0.05). The TT group exhibited longer CPB and aortic clamping times compared to the TARVIAT and MS groups, while demonstrating lower 24-hour postoperative chest drainage volumes compared to the TARIAVT and MS groups. Both the TARVIAT and TT groups showed shorter surgical times, postoperative mechanical ventilation times, postoperative ICU stay, incision lengths, and postoperative hospital. However, there were no statistically significant differences among the three groups regarding hospital costs, postoperative left ventricular ejection fraction (LVEF) values, and the incidence of postoperative complications (p > 0.05). Conclusions: TARVIAT under central CPB is feasible and safe for adult patients. This approach presents lower invasiveness, shorter operative duration, and faster recovery compared to other methods. In conclusion, the TARVIAT approach for repairing adult ASD is both safe and effective, offering a viable surgical option for this condition.

Risk factors for enhanced recovery after surgery failure in patients undergoing lung cancer resection with concomitant cardiovascular disease: A single-center retrospective study

ObjectiveEnhanced recovery after surgery (ERAS) has been widely used in patients with lung cancer, and its effectiveness has been confirmed; however, some lung cancers with poor clinical outcomes lead to ERAS failure after radical resection. This study aimed to analyze risk factors associated with ERAS failure after radical resection in patients with lung cancer and concomitant cardiovascular disease. MethodsIn total, 198 patients who underwent ERAS following radical lung cancer surgery for concomitant cardiovascular disease between January 2022 and September 2023 were enrolled in this retrospective study. The patients were categorized into two groups based on the definition of ERAS failure: ERAS success group (n = 152) and ERAS failure group (n = 46). Univariate and multivariate analyses were performed to investigate the risk factors of ERAS failure. ResultsUnivariate analysis showed that gender, tumor location, operation time, estimated blood loss (EBL), suction drainage, and total cholesterol were associated with ERAS failure. Multivariate analysis showed that operation time (odds ratio [OR] = 1.015; P = 0.011) and suction drainage (OR = 3.343; P = 0.008) were independent risk factors for ERAS failure. ConclusionsOperation time and suction drainage were independent risk factors for ERAS failure after radical resection of combined cardiovascular lung cancer. Therefore, improving surgical efficiency and postoperative chest drain management are important for successful ERAS.

Technical exploration and early results of two-port total thoracoscopic aortic-mitral double-valve replacement

Objective: To examine the clinical outcomes of patients undergoing total thoracoscopic aortic-mitral double-valve replacement. Methods: This is a retrospective case series study. The clinical data of 50 patients who underwent double-valve replacement under a total thoracoscopic two-port approach from November 2021 to August 2022 in the Department of Cardiovascular Surgery, Fujian Medical University Union Hospital were retrospectively analyzed. There were 32 males and 18 females, with an age of (55.3±8.8) years (range: 21 to 62 years). Among them, 36 cases had rheumatic heart disease and 14 cases had infective endocarditis. The 3rd intercostal space between the right anterior axillary line and the midclavicular line was selected as the main operating hole, the total thoracoscopic double-valve replacement were successfully carried out. Baseline data, intraoperative information, surgical outcomes, and postoperative complications were collected for all patients. Results: The cardiopulmonary bypass time was (168.2±30.9) minutes (range: 125 to 187 minutes), the aortic cross-clamping time was (118.8±16.5) minutes (range: 96 to 147 minutes). Five patients received bioprosthetic valves, and 45 received mechanical prosthetic valves. Postoperative mechanical ventilation lasted (9.6±3.4) hours (range: 5.1 to 14.2 hours), the ICU stay was (24.8±7.3) hours (range: 16.3 to 30.1 hours), and the postoperative hospital stay was (6.5±1.2) days (range: 5.0 to 8.0 days). Four patients received red blood cell transfusions of (2.7±0.9) units (range: 2 to 4 units), and the postoperative chest drainage volume was (222.1±56.3) ml (range: 175 to 289 ml). No deaths occurred intraoperatively or in the early postoperative period. One patient required reoperation due to bleeding in the aortic incision. Three patients had mild to moderate paravalvular leakage around the prosthetic aortic valve, with no cases of third-degree atrioventricular block or conversions to median sternotomy. Conclusions: The early outcomes of total thoracoscopic double valve replacement surgery are satisfactory, demonstrating safety and efficacy. This surgical approach expands the scope of total thoracoscopic cardiac surgery, which warrants further investigation and research.

1188 The Effect of Bone Wax Application in Cardiac Surgery: A Systematic Review

Abstract Aim There is limited and conflicting evidence on whether bone wax usage in cardiac surgery increases infection risk. A systematic review was conducted to examine cardiac surgery postoperative outcomes following bone wax application. Method This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The MEDLINE, EMBASE, and Scopus databases were searched for studies evaluating perioperative bone wax usage in the English language. All relevant synonyms of “Cardiac Surgery”, “Bone wax”, “Infection”, and “Healing” were used to identify papers. The outcomes of interest were wound infection, sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality. Results From the 66 articles found, 5 were included following full-text screening. No statistically significant difference in infection risk between the bone wax (BW) and comparator groups existed. However, the evidence suggests bone wax significantly increases the risk of sternal dehiscence. Studies reporting postoperative bleeding showed a significantly greater mean volume in the BW group. All studies reporting postoperative chest drainage (n = 3) showed a greater mean volume in the BW group, of which two were significant. Of the three papers reporting mortality, two showed an increased risk in the BW group. Conclusions Current evidence indicates no significant association between bone wax and wound infection. Bone wax is associated with a greater risk of sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality. Greater emphasis should be placed on bone wax alternatives in clinical practice. Limited data necessitates larger studies, and for clearer guidelines to be established around them.

Comparison of three-dimensional reconstruction and CT-guided Hook-wire segmental resection for pulmonary nodules: a propensity score matching study

ObjectiveTo analyze and compare the clinical application value of three-dimensional reconstruction and computed tomography (CT)-guided Hook-wire localization for row lung segment resection of pulmonary nodules.MethodsRetrospective analysis of the clinical data of 204 patients suffering from pulmonary nodules admitted to the Department of Thoracic Surgery of Gansu Provincial People’s Hospital from June 2016 to December 2022. According to the preoperative positioning method, the group was divided into a 3D reconstruction group (98 cases) and a Hook-wire group (106 cases), respectively. The two groups of patients were propensity score matching (PSM) to compare their perioperative outcomes.ResultsAll patients in both groups underwent successful surgeries without perioperative deaths. After PSM, 79 patients were successfully matched in each group. Two cases of pneumothorax, three cases of hemothorax, and four cases of decoupling occurred in the Hook-wire group; no complications of pneumothorax, hemothorax, and decoupling occurred in the 3D reconstruction group. Compared to the Hook-wire group, the 3D reconstruction group has shorter operative time (P = 0.001), less intraoperative bleeding (P < 0.001), less total postoperative chest drainage (P = 0.003), shorter postoperative tube placement time (P = 0.001), shorter postoperative hospital stay (P = 0.026), and postoperative complications (P = 0.035). There was no statistically significant difference between the two groups in terms of pathological type, TNM staging, and number of lymph node dissection.ConclusionThree-dimensional reconstruction and localization of pulmonary nodules enables safe and effective individualized thoracoscopic anatomical lung segment resection with a low complication rate, which has good clinical application value.

Effects of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients: A propensity score matching study.

To assess the impact of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients. Retrospective analysis of 352 patients with lung cancer treated by minimally invasive surgery completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from October 2019 to October 2022. According to the surgical procedure, the patients were divided into a robotic-assisted thoracic surgery (RATS) group (n = 159) and a video-assisted thoracoscopic surgery group (VATS) (n = 193), respectively. Propensity score matching (PSM) analysis was performed in both groups, and perioperative indicators were recorded. Levels of inflammatory markers (C-reactive protein, CRP; interleukin-6, IL-6) and lymphocyte subsets (CD3+ , CD4+ , CD8+ , andCD4+ /CD8+ ) were measured 1 day before surgery and 1, 3, and 5 days after surgery, respectively. To compare the effects of the two surgical procedures on the trauma and lymphocyte subsets of the patient's organism. One hundred and thirty-eight patients in each group after PSM. Compared with the VATS group, the RATS group had shorter operative time (p < 0.001), less intraoperative bleeding (p < 0.001), less postoperative chest drainage (p = 0.029), shorter postoperative chest drainage time (p = 0.008), and shorter postoperative hospital stay (p = 0.005). The levels of CRP and IL-6 increased in both groups after surgery compared with those before surgery, and the increase was less in the RATS group than that in the VATS group. Postoperative T-lymphocyte levels were lower in both groups compared with preoperative levels, and T-lymphocyte levels were significantly lower in the VATS group compared with the RATS group. Compared with VATS for treating lung cancer, RATS has advantages in short-term efficacy, and smaller surgical trauma to patients, which can reduce the body's inflammatory response. It also has less impact on T lymphocyte subpopulations, which can better protect patients' immune function.

O169 A systematic review on the effect of bone wax application in cardiac surgery

Abstract Introduction Limited and conflicting evidence exists on whether bone wax usage in cardiac surgery increases risk of infection. A systematic review was conducted to examine the cardiac surgery postoperative outcomes following bone wax application. Method Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to in this review. The EMBASE, MEDLINE and Scopus databases were searched for studies evaluating perioperative bone wax usage, excluding non-English papers. All relevant synonyms of Cardiac Surgery, Bone Wax, Infection, and Healing were used for paper identification. Wound infection, sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality were outcomes of interest. Results From the 66 articles identified, 5 were included following full-text screening. No statistically significant difference in infection risk between the bone wax (BW) and comparator groups existed. However, the evidence suggests bone wax significantly increases sternal dehiscence risk. Studies reporting postoperative bleeding showed a significantly greater mean volume in the BW group. All studies reporting postoperative chest drainage (n=3) showed a greater mean volume in the BW group, of which two were significant. Of the three papers reporting mortality, two showed increased risk in the BW group. Conclusion Current evidence indicates no significant association between bone wax and wound infection. Bone wax is associated with increased risk of sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality. Greater emphasis should be placed on bone wax alternatives in clinical practice. Limited data necessitates larger studies, and for clearer guidelines to be established around them.

A comparative study of robotic surgery and thoracoscopic surgery for mediastinal cysts

ObjectiveTo compare the efficacy and safety of robotic-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS) in the treatment of mediastinal cysts.MethodsRetrospective analysis on clinical data of 70 cases of minimally invasive surgery for mediastinal cysts completed in the Department of Thoracic Surgery, Gansu Provincial People’s Hospital from April 2014 to December 2022. There were 34 cases in the RATS group with a cyst diameter of (3.70 ± 1.16) cm and 36 cases in the VATS group with a cyst diameter of (4.07 ± 1.20) cm. All cysts were evaluated preoperatively using magnetic resonance imaging (MRI) or chest computed tomography (CT) localization. Surgery-related indices were compared among the two groups.ResultsAll patients in two groups successfully completed resection of mediastinal cysts without perioperative deaths. Compared with the VATS group, the RATS group possessed shorter operative time [(75.32 ± 17.80) min vs. (102.22 ± 19.80) min, P < 0.001], lesser intraoperative bleeding [10 (5.00, 26.00) ml vs. 17.50 (5.00, 50.50) ml, P = 0.009], shorter postoperative chest drainage time [2 (1.00, 6.00) ml vs. 3 (2.00, 6.50) ml, P = 0.006] and shorter postoperative hospital stay [3 (2.00, 6.50) d vs. 4 (3.00, 7.50) d, P = 0.001]. There was no statistically significant discrepancy in intermediate openings and complications in both groups (P > 0.05).ConclusionCompared with VATS, RATS is safety and effectivity in the treatment of mediastinal cysts and thus has advantages in operative time, intraoperative bleeding, postoperative chest drainage time and postoperative hospital stay.

Patients’ Perceptions of Experiences of Postoperative Chest Drain Tube Insertion: A Pilot Survey

Pleural drainage is a routine procedure conducted after thoracotomy and thoracoscopy. It is used to remove air or excess fluid from a pleural cavity and enables proper lung expansion. Essential elements of care provided during hospitalization and treatment include meeting patients' growing expectations and continually improving quality while optimizing safety. This study aimed to explore patients' experiences with pleural drainage after thoracic surgery and their correlation with socio-demographic data. A pilot survey with an exploratory design was conducted at a large teaching hospital in Poland, in the Department of Thoracic Surgery at the University Clinical Centre in Gdansk. The study involved the analysis of 100 randomly selected subjects with a chest tube drain. A self-designed questionnaire was used to collect social, demographic, and clinical data. Twenty-three questions related to experiences with pleural drainage, ailments, limitations in daily functioning, and security with a chest tube were evaluated using a 5-point Likert scale. Patients completed the questionnaire on the third postoperative day. Individuals fitted with a traditional water-seal drainage system felt safer than those from the digital drainage group (p = 0.017). Statistically significant differences were found in the assessment of nursing assistance (p = 0.025); the number of satisfied patients was greater in a group of unemployed people. No correlation was found between demographic and social factors and the patients' sense of security (gender: p = 0.348, age: p = 0.172, education level: p = 0.154, professional activity: p = 0.665). Demographic and social characteristics did not significantly affect patients' sense of safety with chest drainage types. Patients with traditional drainage felt significantly safer than patients with digital drainage. Patient knowledge of pleural drainage management was not satisfactory, with a number of patients indicating a lack of knowledge in this area. This is important information that should be considered when planning measures to improve the quality of care.

Comparison of the LigaSure™ bipolar vessel sealer to monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy: a prospective randomized controlled trial

BackgroundHigh-energy devices allow better vessel sealing compared with monopolar electrocautery and could improve the outcomes of surgical operations. The objective of the study was to compare tissue dissection by the LigaSure™ device with that by monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy.MethodsThis pragmatic, parallel group, prospective randomized controlled trial was funded by the Medtronic External Research Program (ISR-2016–10,756) and registered at www.clinicaltrials.gov (NCT03125798). The study included patients aged 18 years or older, who had undergone thoracoscopic lobectomy with lymphadenectomy at the Department of Thoracic Surgery of Poznan University of Medical Sciences between May 3, 2018, and November 4, 2021. Using simple randomization, the patients were assigned to undergo tissue dissection with either the LigaSure device (study group) or monopolar electrocautery (control group). Participants and care givers, except operating surgeons, were blinded to group assignment. The primary outcome was postoperative chest drainage volume. Secondary outcomes were change of the esophageal temperature during subcarinal lymphadenectomy and C-reactive protein level 72 h after surgery.ResultsStudy outcomes were analyzed in 107 patients in each group. We found no differences between the study and control groups in terms of chest drainage volume (550 vs. 600 mL, respectively; p = 0.315), changes in esophageal temperature (− 0.1 °C vs. − 0.1 °C, respectively; p = 0.784), and C-reactive protein levels (72.8 vs. 70.8 mg/L, respectively; p = 0.503). The mean numbers of lymph nodes removed were 12.9 (SD: 3.1; 95% CI, 12.4 to 13.5) in the study group and 11.6 (SD: 3.2; 95% CI, 11.0 to 12.2) in the control group (p < 0.001).ConclusionsThe use of the LigaSure device did not allow to decrease the chest drainage volume, local thermal spread, and systemic inflammatory response. The number of lymph nodes removed was higher in patients operated with the LigaSure device, which indicated better quality of lymphadenectomy.

Totally endoscopic aortic valve replacement: Techniques and early results.

To demonstrate the technical details of total endoscopic aortic valve replacement using a standard prosthesis, compare the clinical effect and safety of endoscopic aortic valve replacement and traditional aortic valve replacement. From 2020 to 2021, 60 consecutive patients underwent elective isolated aortic valve replacement (AVR). They were divided into two groups: the total endoscopic AVR group (TE-AVR group, 29 patients, nine women, aged 51.65 ± 11.79 years), and the traditional full-sternotomy group (AVR group, 31 patients, 13 women, aged 54.23 ± 12.06 years). Three working ports were adopted in the TE-AVR procedure. No patient died in either group. The cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time in the TE-AVR group were longer than those in the AVR group (CPB time: 177.6 ± 43.2 vs. 112.1 ± 18.1 min, p < 0.001; ACC time: 118.3 ± 29.7 vs. 67.0 ± 13.2 min, p < 0.001). However, the mechanical ventilation duration (14.2 ± 9.3 vs. 24.0 ± 18.9 h, p = 0.015) and postoperative hospital stay (6.0 ± 1.7 vs. 8.0 ± 4.5 days, p = 0.025) were shorter in patients of TE-AVR group than those of AVR group. Although the ICU stay (55.1 ± 26.9 vs. 61.5 ± 44.8 h, p = 0.509) and post-operative chest drainage of the first 24 h (229.8 ± 125.0 vs. 273.2 ± 103.2 ml, p = 0.146) revealed no statistical difference, there was a decreasing trend in the TE-AVR group. Among the patients of the TE-AVR group, two patients were converted to thoracotomy because of mild to moderate paravalvular leakage identified by intraoperative transesophageal echocardiography. Total endoscopic aortic valve replacement is safe and feasible, with less trauma and quicker recovery.

Complications and outcome of traumatic diaphragmatic hernia repair without post-operative chest drain: Retrospective study in 90 cats.

Diaphragmatic herniorraphy is the treatment of choice for traumatic diaphragmatic hernia (TDH). Several methods have been described for the removal of residual air and fluid during and after surgery, such as the insertion of chest drains, intercostal thoracentesis, and transdiaphragmatic thoracentesis. However, there are no indications regarding the most useful technique and the impact that choice of technique could have in the immediate postoperative period. To evaluate the development of complications and outcomes associated with the use of intraoperative transdiaphragmatic thoracentesis in cats undergoing diaphragmatic herniorrhaphy for TDH. Medical records of cats treated for acute and chronic TDH between 2010 and 2019 were reviewed. Cats were included if intraoperative pneumothorax was treated with transdiaphragmatic thoracentesis, without the use of intercostal chest drain. Outcome, intra- and post-operative complications were recorded. Intraoperative and postoperative complication rates were 3.3% and 12.4%, respectively. Development of postoperative pneumothorax was associated with the presence of comorbidities (p = 0.046). The overall survival rate was 93.3%. Long-term survival had a significant association with the presence of comorbidities (p = 0.045), if the procedure was performed as an emergency (p = 0.041) or in older cats (p = 0.011). Intraoperative transdiaphragmatic thoracentesis could be considered an effective method for the removal of residual air after surgery for TDH, because it ensures a good outcome for the patient, with low development of complications, especially for uncomplicated cases. The presence of comorbidities, the need to perform a surgical procedure in emergency, and the age of the patient can be considered factors influencing the development of complications. Critical patient selection, based on assessment of potential risk factors for complications is warranted to understand which patient will benefit from thoracostomy tube placement.

Analysis of the efficacy of the da Vinci robot in surgery for posterior mediastinal neurogenic tumors

BackgroundThe present research is designed to evaluate the short-term outcome of robot-assisted thoracoscopic surgery (RATS) for the treatment of posterior mediastinal neurogenic tumors.MethodsWe retrospectively analyzed clinical data on 39 consecutive patients with mediastinal neurogenic tumors after RATS treatment completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from January 2016 to September 2022. There were 22 males and 17 females with a mean age of (35.1 ± 6.9) years in this analysis report. The tumors of the patients were localized and evaluated preoperatively using magnetic resonance imaging (MRI) or enhanced CT.ResultsAll 39 patients successfully underwent the resection of posterior mediastinal neurogenic tumors under RATS, and no conversion to thoracotomy occurred during the operations. The average operative time was (62.1 ± 17.2) min, the average docking time was (10.1 ± 2.5) min, the average intraoperative bleeding was (32.8 ± 19.5) ml, the average 24-h postoperative chest drainage was (67.4 ± 27.9) ml, the average postoperative chest drainage time was (2.2 ± 1.3) days and the average post-operative hospital stay was (3.2 ± 1.3) days. Postoperative complications occurred in 3 patients, including 2 patients with transient Horner's syndrome after surgery and 1 patient with transient anhidrosis of the affected upper limb after surgery.ConclusionRATS for posterior mediastinal neurogenic tumors is safe, effective, feasible and bring the superiority of robotic surgical system into full play.

Optimal Chest Drainage Method After Anatomic Lung Resection: A Prospective Observational Study

BackgroundSeveral methods for chest drainage after pulmonary resection of malignant lung tumors exist, but consensus on the ideal method has not been reached. MethodsWe conducted a multicenter prospective observational study. We enrolled 2200 patients who underwent lung resection for lung tumors. Of the 1470 patients who underwent anatomic resection, 347 showed air leak on the morning of postoperative day 1. They were assigned to 3 groups according to the chest drainage method on postoperative day 1. ResultsOf 347 patients with postoperative air leaks, 107 (30.8%), 179 (51.6%), and 61 (17.6%) were assigned to water seal, continuous suction, and digital drainage, respectively. The median postoperative air leak duration was significantly longer with digital drainage (4.0 days) than with either water seal (2.5 days) or continuous suction (3.0 days; P = .009). Chest tubes were required for significantly more days on average with digital drainage (6.0 days) than with water seal (4.0 days) or continuous suction (4.0 days; P = .003). Prolongation of air leak duration was significantly more likely to occur in patients with body mass index <18.5 kg/m2 (hazard ratio [HR], 1.6; 95% CI, 1.1-2.3), moderate or severe air leak on postoperative day 1 (HR, 2.0; 95% CI, 1.5-2.6), or digital drainage (HR, 1.4; 95% CI, 1.01-1.9). ConclusionsWater seal was associated with significantly shorter duration of postoperative air leak and chest drainage compared with continuous suction and digital drainage.

Complex vs. simple segmentectomy: comparing surgical outcomes in the left upper division.

Lung segmentectomy is an option for the treatment of noninvasive or minimally invasive lung cancer. For tumors located in the left upper division (LUD), LUD trisegmentectomy (S1+2 + S3) is frequently performed as a sublobar resection because of its technical simplicity. However, the differences in surgical outcomes between simple and complex segmentectomies remain unclear. We compared the surgical outcomes and frequency of postoperative complications of LUD trisegmentectomy (simple group) with those of complex segmentectomy (other than LUD trisegmentectomy; complex group) for pulmonary lesions using three-dimensional computed tomography between 2010 and 2021. In total, 118 patients were included: 65 in the simple group and 53 in the complex group (S1+2: 25, S3: 15, others: 13). There were no significant differences in surgical time or duration of postoperative chest drainage. However, the blood loss volume was significantly smaller in the complex group than in the simple group (12 vs. 36mL, p = 0.023), and major complications tended to occur less frequently in the complex group than in the simple group (3.8 vs. 13.8%, p = 0.061). Among patients who underwent intentional segmentectomy for primary lung cancer (n = 61), major complications were significantly less common in the complex group (p = 0.006). Complex segmentectomy can be performed safely under the guidance of three-dimensional CT. Complex segmentectomy itself is not a risk factor for postoperative complications when the intersegmental planes are sufficiently recognized and accurately cut.

Clopidogrel Loading Dose 300 vs. 600 mg in Patients Undergoing One-Stop Hybrid Coronary Revascularization: A Prospective Single-Center Randomized Pilot Study.

Background: The optimal loading dose of clopidogrel in one-stop hybrid coronary revascularization (HCR) remains an “evidence-free” zone. This study aimed to compare the major bleeding and ischemic thrombotic events between different clopidogrel loading doses (300 vs. 600 mg) in one-stop HCR.Methods: In this prospective, single-center, randomized, and parallel pilot study, 100 patients receiving one-stop HCR were randomly assigned to the clopidogrel loading dose 300-mg group or 600-mg group in a 1:1 ratio. Major bleeding events and composite in-hospital ischemic thrombotic and adverse complications were evaluated after the procedure.Results: The results showed that postoperative mean chest drainage of the first 4 days and total drainage were comparable between the two groups. No differences were found in Bleeding Academic Research Consortium (BARC) coronary artery bypass grafting (CABG) related bleeding (4 vs. 2%, P = 1), PLATelet inhibition and patient Outcomes (PLATO) life-threatening bleeding (20 vs. 26%, P = 0.48), and PLATO major bleeding (70 vs. 76%, P = 0.5) in the two groups. The composite ischemic thrombotic and adverse events were also similar.Conclusions: In patients receiving one-stop HCR, clopidogrel 600 mg loading dose did not increase major bleeding events compared with 300 mg. More sufficient data is necessary to evaluate the potential benefits of 600 mg loading dose in one-stop HCR.

Levosimendan administration is not associated with increased risk of bleeding and blood transfusion requirement in patients undergoing off-pump coronary artery bypass grafting: a retrospective study from single center.

Levosimendan (LEVO) is a positive inotropic drug which could increase myocardial contractility and reduce the mortality rate in cardiac surgical patients. However, Whether LEVO is associated with postoperative bleeding and blood transfusion in cardiac surgical patients is controversial. Therefore, the current study was designed to investigate the impact of LEVO administration on bleeding and blood transfusion requirement in off-pump coronary artery bypass grafting (OPCAB) patients. In a retrospective analysis, a total of 292 patients, aged 40-87 years, undergoing elective OPCAB between January 2019 and July 2019, were divided into LEVO group (n = 151) and Control group (n = 141). Patients in LEVO group continuously received LEVO at a rate of 0.1-0.2 μg kg-1 min-1 after anesthesia induction until 24 hours after OPCAB or patients in Control group received no LEVO. The primary outcome was postoperative chest drainage volume. The secondary outcomes were reoperation for postoperative bleeding, transfusion requirement of red blood cells (RBCs), fresh frozen plasma (FFP) and platelet concentrate (PC), etc. Comparisons of two groups were performed with the Student's t-test or Wilcoxon-Mann-Whitney test. There was no significant difference with respect to chest drainage volume ((956.29 ± 555.45) ml vs (1003.19 ± 572.25) ml, p = 0.478) and the incidence of reoperation for postoperative bleeding (1.32% vs 1.42%, p = 0.945) between LEVO group and Control group. The transfusion incidence and volume of allogeneic RBCs, FFP, and PC were comparable between two groups. LEVO administration was neither associated with more postoperative blood loss nor increased allogeneic blood transfusion requirement in OPCAB patients.

Effect and feasibility of uniportal thoracoscopic surgery in the treatment of early-stage lung cancer in a primary hospital.

BackgroundThoracoscopic radical lobectomy is a routine procedure for radical surgery of lung cancer. Meanwhile, thoracoscopic surgery has been gradually transformed from assisted small incision and multiport thoracoscopic radical surgery to uniportal thoracoscopic surgery for treatment of early-stage lung cancers. However, there are still controversies regarding the efficacy and feasibility of 2 surgical methods. The purpose of this study is to investigate the effect and feasibility of uniportal thoracoscopic surgery for treatment of early-stage lung cancer in a primary hospital.MethodsClinical data of 142 patients with early-stage lung cancer were retrospectively chosen in the period from September 2019 to March 2021 in our hospital and divided into 2 groups: a control group (66 patients) with 3-port thoracoscopic radical surgery and an experimental group (76 patients) with uniportal thoracoscopic radical surgery. The baseline clinical data, perioperative clinical data, and lymph node dissection of 2 groups were compared.ResultsThere was no significant difference in baseline general clinical data between 2 groups (P>0.05), and no significant difference in the incidence of postoperative complications, conversion rate, or operation time between 2 groups (P>0.05). The intraoperative blood loss volume, postoperative chest drainage volume, postoperative hospitalization time, and postoperative catheter time of experimental group were significantly lower than those of control group (P<0.05). There was no significant difference in the total number of lymph node dissection stations and lymph node dissections, the number of N2 lymph node dissection stations, or N2 lymph node dissections between 2 groups (P>0.05). There was also no significant difference in the number of left and right lymph node dissection stations between 2 groups (P>0.05).ConclusionsCompared with 3-port thoracoscopic radical surgery, uniportal thoracoscopic radical surgery in the treatment of patients with early-stage lung cancer provides the same effect of lymph node dissection and has advantages in reducing surgical trauma and accelerating postoperative rehabilitation, popularizing for use in primary hospitals.

Antifibrinolytics reduces blood loss in thoracic surgery: a systematic review and meta-analysis.

The purpose of this systematic review is to evaluate the efficacy of antifibrinolytics in non-cardiac thoracic surgery. We searched for all randomized controlled trials on this topic. A set of strict inclusion and exclusion criteria was developed. Six studies were meta-analysed together then in subgroups of topical tranexamic acid and intravenous aprotinin. We compared postoperative chest drain output, transfusions requirements and duration of hospital stay where available to determine the efficacy of topical tranexamic acid or intravenous aprotinin in reducing blood loss. The use of antifibrinolytics reduces 24-h chest drain output (-290.21 mL [-524.75, -55.66], P= 0.02, I2 = 98%), red blood cell transfusion requirements (-1.27 units [-2.24, -0.30], P= 0.01, I2 = 100%) and shortened duration of hospital stay (-1.81 days [-3.25, -0.36], P= 0.01, I2 = 96%). The subgroup analysis also supported this trend. We conclude that the use of antifibrinolytics appears to reduce postoperative blood loss by reducing chest drain output, transfusion requirements and length of stay after thoracic surgery.