Thoracotomy Rate Research Articles

A Rare Case of a Child with Bended Scarf-Pin in Left Bronchus: Case Report with Systematic Review And Meta-Analysis.

In this report, we present the case of a 19-month-old female diagnosed with hijab pin aspiration after a week of persistent coughing, along with a meta analysis and systematic review of the relevant literature. A comprehensive search was conducted across multiple databases, including Ovid Medline, Cochrane, PubMed, Web of Science, and SCOPUS, yielding 182 records until August 2024. A total of 7 published study and our case included to final analysis. The complication, morbidity, and mortality analysis has been performed using Jamovi software v2.4 MAJOR proportion analysis section. A 19-month-old female was admitted to another hospital with a persistent cough complaint. In X-ray left hijab pin has been detected. The patient underwent a succesfull removal with rigid broncoscopy (RB). A total of 71 patients included this meta analysis. The thoracotomy rate was 8%. The bleeding rate was reported as 1.4%. The reoperation rate was reported as 9.8%. The postoperative intubation rate was reported as 1.4%. The calculated complication rate was found to be 5.6% based on the existing literature. The postoperative hemoptysis incidence was calculated as 0%. Mortality was not reported across any included studies. However, the mortality incidence was calculated as 0% based on included studies. Effective and timely intervention is crucial for managing pediatric hijab pin aspiration. Multidisciplinary approaches ensure successful outcomes and prevent serious complications.

Meta-analysis of clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors

ObjectiveComparing the clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors using meta-analysis.MethodsComputer retrieval of PubMed, Embase, The Cochrane Library, and Web of Science databases for literature comparing the clinical effects of video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) in treating mediastinal tumors, with the retrieval time limit from the establishment of the database to September 2023. Two evaluators independently screened the literature, extracted data, and assessed the risk of bias. Meta-analysis was performed using RevMan 5.4.ResultsA total of 19 articles were included, with a total of 3517 patients. The results of the Meta-analysis showed that the RATS group had less intraoperative bleeding [MD = − 5.20, 95%CI (− 9.28, − 1.12), P = 0.01], lower rate of conversion to thoracotomy [OR = 0.41, 95%CI (0.23, 0.72), P = 0.002], lower rate of total postoperative complications [OR = 0.57, 95%CI (0.34, 0.95), P = 0.03], shorter postoperative drainage time [MD = − 0.72, 95%CI (− 1.13, − 0.32), P = 0.0004], and shorter postoperative hospital stay [MD = − 0.90, 95%CI (− 1.16, − 0.65), P < 0.001], in comparison with the VATS group. There was an insignificant difference between the two groups in terms of tumor size [MD = − 0.02, 95%CI (− 0.33, 0.30), P = 0.91] and operation time [MD = 0.17, 95%CI (− 7.61, 7.94), P = 0.97]. However, in regards to hospitalization costs [MD = 2634.75, 95%CI (991.62, 4277.88), P = 0.002], the RATS group was more expensive than the VATS group.ConclusionRobot-assisted mediastinal tumor resection surgery has more advantages in terms of intraoperative bleeding, conversion to thoracotomy rate, total postoperative complication rate, postoperative drainage time, and postoperative hospital stay, in comparison with thoracoscopic-assisted mediastinal tumor resection surgery. There is an insignificant difference in tumor size and operation time between the two surgeries. However, robot-assisted mediastinal tumor resection surgery increases hospitalization costs.

The Success Rate of Emergency Department Thoracotomy for Emergency Penetrating Chest Trauma

Background and Aim: Trauma is considered one of the causes of mortality worldwide, among which chest injury is responsible for most of these deaths. This study aims to investigate the success rate of emergency thoracotomy in penetrating chest trauma in the emergency department of Shahid Beheshti and Farghani Hospital. Materials and Methods: This study was conducted retrospectively by reviewing the files of patients with penetrating trauma from 2011 to 2021. The inclusion criteria comprised all cases that underwent emergency thoracotomy with chest trauma. Meanwhile, the exclusion criteria were incomplete cases and cases that underwent thoracotomy for other reasons (such as non-emergency thoracotomy, open heart operation, or non-traumatic thoracotomy). In addition, the files of other patients who had underlying diseases, such as cardiovascular diseases were excluded from the study. The study variables, including age, gender, mechanism of trauma, the severity of the trauma, area of ​​trauma, vital signs on arrival, time to reach the operating room, and death or survival of patients were extracted from patient files and entered into the SPSS software, version 22. Finally, the data were analyzed by the Chi-square test and the paired t-tests. The significance level for all tests was considered 0.5. Results: The average age of the patients was 32.67±13.16 years and 50(34.7%) patients were female while 94(65.3%) patients were male. A total of 91(63.2%) patients died and 53(36.8%) patients survived. The average time from injury to thoracotomy in the emergency department was 20.4±8.9 minutes. Thoracotomy was successful in 19(13.2%) women and 94 (65.3%) men. No significant correlation was found between gender (P=0.82), the mechanism of injury (P=0.58), the severity of injury (P=0.27), and the location of injury (P=0.15). The referral method of patients with successful thoracotomy was not found (P=0.39). The average duration of patients reaching the hospital until thoracotomy was performed in the emergency department was 17.5±6.69 minutes among the patients who survived and 22.14±9.6 among the patients who died. A significant correlation was found between the time from the injury and thoracotomy and the success of thoracotomy in patients (P=0.03). Conclusion: Finally, the results showed as the average time between injury and thoracotomy gets shorter, the chance of success in thoracotomy increases.

Perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic lobectomy: A propensity score matched analysis.

The existing literature on perioperative outcomes of robotic-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for lung lobectomy is inconclusive. We conducted a retrospective cohort analysis of VATS and RATS lobectomy procedures for patients with non-small cell lung cancer to compare the short-term perioperative outcomes by propensity score matching (PSM) analysis. A total of 418 patients were enrolled in this study. After PSM, 71 patients each received VATS and RATS lobectomy for further analysis. RATS lobectomy was associated with a lower rate of conversion to thoracotomy (0% vs. 5.63%, p = 0.006), a lower rate of postoperative prolonged air leak (1.14% vs. 19.72%, p = 0.001) and a shorter duration of postoperative chest tube drainage (3 days interquartile range [IQR: 3, 4] vs. 4 days IQR [3-5], p = 0.027). Subgroup analysis indicated that after acquiring proficiency in the RATS procedure, its disadvantages diminished while its advantages were enhanced. In terms of rate of conversion to thoracotomy, length of hospital stays, and duration of postoperative chest tube drainage, RATS was comparable to uniportal VATS and superior to triportal VATS. RATS has advantages over VATS in terms of early chest tube removal, early discharge, lower thoracotomy rate, less postoperative air leak, and a potential trend of more lymph node dissection numbers. These advantages are more pronounced after acquiring proficiency in RATS.

Effect of perioperative aspirin continuation on bleeding after pneumonectomy

To investigate the effect of continuous oral aspirin in perioperative period on bleeding in pneumonectomy. A total of 170 patients who underwent pneumonectomy in our hospital from March 2021 to March 2022 were selected as the study objects. All patients took oral aspirin before surgery and did not take other antiplatelet agent or anticoagulants at the same time. The continuation group included 85 cases and continued to take aspirin 100 mg/day during the perioperative period, and the interruption group included 85 cases who stopped aspirin for 7 days before surgery and 3 days after surgery, without bridging therapy. The intraoperative blood loss, operation time, conversion to thoracotomy rate, postoperative bleeding rate, blood transfusion rate, thrombotic events, postoperative drainage volume, length of hospital stay, and total hospital cost of the two groups were compared. There were no statistically significant differences in intraoperative blood loss, operative time, rate of conversion to open, postoperative drainage, hospital stay, and cost between the two groups (p > 0.05), and there were no reoperations due to bleeding between the two groups. Aspirin should be continued throughout the perioperative period in all high-risk patients requiring pneumonectomy after balancing ischemic-bleeding risks.

Clinicopathological features and surgical outcomes of lobectomy combined with segmentectomy: a cohort study.

Segmentectomy is a standard procedure, and there is considerable data on routine segmentectomies. However, there are only few reports on lobectomy performed in combination with segmentectomy (lobectomy + segmentectomy). Thus, we aimed to clarify the clinicopathological features and surgical outcomes of lobectomy + segmentectomy. We reviewed patients who underwent lobectomy + segmentectomy between January 2010 and July 2021 at Gunma University Hospital, Japan. We comparatively analyzed clinicopathological data of patients who underwent lobectomy + segmentectomy and those who underwent lobectomy in combination with wedge resection (lobectomy + wedge resection). We collected data from 22 patients who underwent lobectomy + segmentectomy and 72 who underwent lobectomy + wedge resection. Lobectomy + segmentectomy was mainly performed to treat lung cancer, and the median number of resected segments was 4.5 and the median number of lesions was 2. Lobectomy + segmentectomy was associated with a higher rate of thoracotomy and a longer operation time. Incidence of overall complications, including pulmonary fistula and pneumonia was higher in the lobectomy + segmentectomy group. However, there were no significant differences in the length of drainage, major complications, and mortality. For lobectomy + segmentectomy, the only left-sided procedure was a left lower lobectomy + lingulectomy, whereas procedures were diverse on the right side, mostly combining a right upper or middle lobectomy with atypical segmentectomies. Lobectomy + segmentectomy was performed for (I) multiple lung lesions, (II) lesions invading an adjacent lobe, or (III) lesions with a metastatic lymph node invading the bronchial bifurcation. Although lobectomy + segmentectomy is a lung-preserving procedure that can benefit patients with multiple or advanced diseases involving two lobes, this procedure should still be performed following a careful patient selection process.

Optimum Timing of Video Assisted Thoracoscopic Surgery in Acute Chest Injury

Objective: To compare the length of hospital stay, duration of chest tube drainage use, conversion to open thoracotomy and post-injury chest infections between the Early VATS and Late VATS groups.&#x0D; Study Design: Cross-sectional comparative study.&#x0D; Place and Duration of Study: Department of surgery Benazir Bhutto Hospital, Rawalpindi Pakistan, from Oct 2020 till Sep 2022.&#x0D; Methodology: Sixty-two patients undergoing VATs for acute chest injury were divided into two groups; early VATs within first 5 days of chest injury and late VATs after 5th day of chest injury. Outcome variables compared between the two groups were length of hospital stay, duration of chest tube drainage, conversion to open thoracotomy and chest infection rate. Numericaldata were compared using the independent sample T-test and categorical variables were compared using the Chi square test. A p-value of &lt; 0.05 was considered statistically significant. &#x0D; Results: In our study the Early VATS group had a significantly shorter length of hospital stay, lesser days on ventilator, shorter total duration of chest tube drainage as compared to Late VATS group. However, duration of post VATS tube drainage, requirement for secondary VATS and conversion rate to open thoracotomy were similar in both groups. Moreover, infection rate was significantly lower in the Early VATS group.&#x0D; Conclusion: Early VATS in chest injury is associated with better clinical outcome.

Local control and short-term outcomes after VATS segmentectomy vs lobectomy for pT1c pN0 NSCLC (2–3 cm)

Abstract Objective Pulmonary segmentectomy has shown comparable oncological results to lobectomy for non-small cell lung cancers (NSCLC) of less than 2 cm. However, controversy remains for tumors of larger size. The aim of this study was to compare short-term outcomes and local control in pT1c pN0 NSCLC that were intentionally treated by VATS segmentectomy or lobectomy. Methods Multicenter retrospective study from January 2014 to October 2021 of 162 consecutive patients undergoing complete (R0) anatomical resections for pT1c pN0 NSCLC. Two groups, VATS lobectomy (VL) or VATS segmentectomy (VS) were defined according to the extension of the resection. Patients’ characteristics, postoperative outcomes and survival were compared. Results In total, 162 patients underwent VL (n=81) or VS (n=81). Except for age (median of 68 vs 71 years, p=0.034) and past medical history of cancer (32% vs 48%, p=0.038), there was no difference between VL and VS in terms of demographics and comorbidities (table1). Segmentectomies were performed in upper lobes in 68% and single segments represented 46% of all cases. Conversion thoracotomy rate was 5% in both groups. Morbidity were similar in both groups (34% vs 30%, p=0.5). The median time for chest tube removal (3 vs 2 days, p=0.002) and median LOS (6 vs 5 days, p=0.039) were in favor of the VS group. Significantly larger tumor (25 mm vs 23.5 mm p=0.001) and an increased number of lymph nodes removal (median 14 vs 10, p&amp;lt;0.001) were found in the VL group. During the follow-up (median: 31 months), no statistical difference was found for local and distant recurrence in VL groups (12.3%) and VS group (6.2%) (p=0.414). Overall survival was comparable in-between both groups (p=0.166). Conclusion Despite a short follow-up, our preliminary data shows that local control is comparable for VATS lobectomy and VATS segmentectomy. Further prospective randomized trials are needed to corroborate these results.

Robotic-assisted thoracoscopic surgery demonstrates a lower rate of conversion to thoracotomy than video-assisted thoracoscopic surgery for complex lobectomies.

Locally advanced lung cancers present a significant challenge to minimally invasive thoracic surgeons. An increasing number of centres have adopted robotic-assisted thoracoscopic surgeries for these complex operations. In this study, we compare surgical margins achieved, conversion rates to thoracotomy, perioperative mortality and 30-day readmission rates for robotic and video-assisted thoracoscopic surgery (VATS) lobectomy for locally advanced lung cancers. Using the National Cancer Database, we identified patients with non-small-cell lung cancer who received neoadjuvant chemotherapy/radiotherapy, had clinical N1/N2 disease or in the absence of these 2 features had a tumour >5 cm treated with either robotic or VATS lobectomy between 2010 and 2016. Perioperative outcomes and conversion rates were compared between robotic and VATS lobectomy. A total of 9512 patients met our inclusion criteria with 2123 (22.3%) treated with robotic lobectomy and 7389 (77.7%) treated with VATS lobectomy. Comparable R0 resections, 30- and 90-day mortality and 30-day readmission rates were observed for robotic and VATS lobectomy while a higher rate of conversion to thoracotomy was observed for VATS (aOR = 1.99, 95% confidence interval = 1.65, 2.39, P < 0.001). Our analysis of the National Cancer Database suggests that robotic lobectomy for complex lung resections achieves similar perioperative outcomes and R0 resections as VATS lobectomy with the exception of a lower rate of conversion to thoracotomy.

Robotic-assisted lobectomy for malignant lung tumors.

Objectives:For patients with lung cancer, surgical resection remains the best curative option and is associated with the longest disease-free survival. We present our institutional outcomes treating pulmonary malignancy with robotic lobectomy over the course of 1 year.Methods:A retrospective review was conducted on patients who underwent robotic pulmonary lobectomy for malignancy at a single institution in 2018.Results:Over the course of 1 year, 166 patients underwent robotic lobectomy for pulmonary neoplasm. The mean age of the patients was 75 years; 73% were current or prior smokers and 52% of the patients were male. The mean body mass index was 28 kg/m2. Conversion to open thoracotomy occurred in 7% of patients. The mean total hospital length of stay (LOS) was 3 days. Histopathological examination revealed a mean tumour size of 2.7 cm with 11 lymph nodes harvested. Left-sided tumours had a significantly higher number of lymph nodes harvested when compared to right-sided tumours (11.6 vs. 9.8, P = 0.01), despite sampling the recommended minimum of three N2 stations. The most common pathology was adenocarcinoma (65%), followed by squamous cell carcinoma (17%) The 30-day operative mortality was 0.6%.Conclusions:Robotic video-assisted thoracoscopic surgery is a safe, feasible and oncologically adequate procedure for lung malignancies. Comparison of our outcomes to previously reported national averages suggests a similar hospital LOS, lymph node harvest, conversion rate to open thoracotomy and 30-day mortality rate. We acknowledge the limitations of this non-randomised, retrospective study. Future research on robotic lobectomies is encouraged.

A national evaluation of emergency department thoracotomy practices: Will a high-risk, low-yield procedure reveal potential management practice bias?

BackgroundEmergency department thoracotomy is often performed on patients in extremis from traumatic exsanguination. Thus, inherent biases may play a role in whether or not the emergency department thoracotomy is performed. We aimed to investigate race, socioeconomic status, and gender disparities in the use of emergency department thoracotomy and to investigate outcomes of these patients to assess for possible surgeon practice bias. MethodA nationwide retrospective cohort analysis of the American College of Surgeons Trauma Quality Programs Participant Use Profile 2016–2018. Adult patients who suffered blunt, penetrating, or other injuries secondary to falls/firearms/motor vehicle collision/other mechanisms of injury and presented to a trauma center pulseless, with or without signs of life after injury. Rates of thoracotomy, time to thoracotomy, transfer to operating room, emergency department disposition, intensive care unit length of stay, hospital length of stay, complications, mortality, and hospital disposition. Univariate analyses and adjusted multivariable regression were performed to account for confounders with significance defined as P < .05. ResultsA total of 6,453 patients were analyzed. Emergency department thoracotomy and mortality were significantly higher in minorities and uninsured patients, even after risk adjustment. There were no differences in timing among race groups to emergency department thoracotomy. White/Caucasian patients experienced the highest rate of emergency department initial disposition to the intensive care unit (10.3%, P < .0001) and lowest mortality rate (89.2%, P < .0001). ConclusionSurgeon bias was not seen in the practice of emergency department thoracotomy for patients arriving pulseless. However, poorer outcomes were associated with minorities and lower socioeconomic status patients. Thoracotomy rates were higher in minorities and lower socioeconomic status patients due to more penetrating trauma.

Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry

ObjectivesObesity in Europe, and worldwide, has been an increasing epidemic during the past decades. Moreover, obesity has important implications regarding technical issues and the risks associated with surgical interventions. Nevertheless, there is a lack of evidence assessing the influence of obesity on video-assisted thoracic surgery (VATS) lobectomy results. Our study aimed to assess the impact of morbid obesity on perioperative clinical and oncological outcomes after VATS lobectomy using a prospectively maintained nationwide registry.MethodsThe Italian VATS lobectomy Registry was used to collect all consecutive cases from 55 Institutions. Explored outcome parameters were conversion to thoracotomy rates, complication rates, intra-operative blood loss, surgical time, hospital postoperative length of stay, chest tube duration, number of harvested lymph-node, and surgical margin positivity.ResultsFrom 2016 to 2019, a total of 4412 patients were collected. 74 patients present morbid obesity (1.7%). Multivariable-adjusted analysis showed that morbid obesity was associated with a higher rate of complications (32.8% vs 20.3%), but it was not associated with a higher rate of conversion, and surgical margin positivity rates. Moreover, morbid obesity patients benefit from an equivalent surgical time, lymph-node retrieval, intraoperative blood loss, hospital postoperative length of stay, and chest tube duration than non-morbid obese patients. The most frequent postoperative complications in morbidly obese patients were pulmonary-related (35%).ConclusionOur results showed that VATS lobectomy could be safely and satisfactorily conducted even in morbidly obese patients, without an increase in conversion rate, blood loss, surgical time, hospital postoperative length of stay, and chest tube duration. Moreover, short-term oncological outcomes were preserved.

Pretreatment clamping of pulmonary artery during uniportal thoracoscopic lobectomy

BackgroundIntraoperative pulmonary artery (PA) hemorrhage is one of the leading reasons for conversion from uniportal VATS to open thoracotomy, especially for the small incision (≤3 cm) uniportal VATS performed by our department. So, We designed a technology called pretreatment clamping of the pulmonary artery, which may be helpful to solve the problem.MethodsA retrospective analysis of 19 patients who had pulmonary artery bleeding during uniportal thoracoscopic lobectomy in which one group had undergone preventive pulmonary artery clamping, the clamping group (n = 11), and one group which did not receive preventive clamping, the non-clamping group (n = 8). We compared the rates of conversion from the uniportal VATS approach to open thoracotomy or multi-incision operation, duration of pulmonary artery repair, blood loss, length of postoperative hospital stay and postoperative complications of the two groups.ResultsCompared to the non-clamping group, the clamping group had lower rates of conversion to open thoracotomy (0% vs 62.5%, p < 0.05) and lower rates of conversion to multi-incision operations (18.2% of non-clamping converted to 2-port approach vs 12.5% of clamping converted to 2-port approach and 12.5% converted to 3-port approach, p < 0.05). Duration of pulmonary artery repair was reduced in the clamping group (10.1 ± 3.2 min vs 18.3 ± 5.5 min, p < 0.05). The clamping group also had decreased blood loss (23.6 ± 11.2 ml vs 47.5 ± 14.9 ml, p<0.05). There were no significant differences in postoperative hospital stay and postoperative complications between the two groups.ConclusionPretreatment clamping of the pulmonary artery in VATS lobectomy can decrease conversion rates, decrease blood loss, shorten repairing time of the pulmonary artery, and feasibly can be applied in uniportal thoracoscopic lobectomy.

Penetrating injury to the cardiac box.

A penetrating injury to the "cardiac box" is thought to be predictive of an injury to the heart; however, there is very little evidence available to support this association. This study aims to evaluate the relationship between penetrating trauma to the cardiac box and a clinically significant injury. All patients presenting to a Level I trauma center from January 2009 to June 2015 who sustained a penetrating injury isolated to the thorax were retrospectively identified. Patients were categorized according to the location of injury: within or outside the historical cardiac box. Patients with concurrent injuries both inside and outside the cardiac box were excluded. Clinical demographics, injuries, procedures, and outcomes were compared. During this 7-year period, 330 patients (92% male; median age, 28 years) sustained penetrating injuries isolated to the thorax: 138 (42%) within the cardiac box and 192 (58%) outside the cardiac box. By mechanism, 105 (76%) were stab wounds (SW) and 33 (24%) were gunshot wounds (GSW) inside the cardiac box, and 125 (65%) SW and 67 (35%) GSW outside the cardiac box. The overall rate of thoracotomy or sternotomy (35/138 [25.4%] vs. 15/192 [7.8%], p < 0.001) and the incidence of cardiac injury (18/138 [13%] vs. 5/192 [2.6%], p < 0.001) were significantly higher in patients with penetrating trauma within the cardiac box. This was, however, dependent on mechanism with SW demonstrating a higher incidence of cardiac injury (15/105 [14.3%] vs. 3/125 [2.4%], p = 0.001) and GSW showing no significant difference (3/33 [9.1%] vs. 2/67 [3%], p = 0.328]. There was no difference in overall mortality (9/138 [6.5%] vs. 6/192 [3.1%], p = 0.144). The role of the cardiac box in the clinical evaluation of a patient with a penetrating injury to the thorax has remained unclear. In this analysis, mechanism is important. Stab wounds to the cardiac box were associated with a higher risk of cardiac injury. However, for GSW, injury to the cardiac box was not associated with a higher incidence of injury. The diagnostic interaction between clinical examination and ultrasound, for the diagnosis of clinically significant cardiac injuries, warrants further investigation. Prognostic study, Level IV, Therapeutic V.

Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction.

Transvenous lead extraction (TLE) may be performed by superior approach using the original implant vein or via a femoral approach; however, limited comparative data exists. We compare outcomes between femoral versus nonfemoral TLE approaches and determine predictors of bailout transfemoral lead extraction in patients undergoing initial TLE via the original implant vein by a superior approach. All consecutive TLEs between October 2000 and March 2018 were prospectively collected (n=1052). Patients were dichotomized into femoral (n=118) and nonfemoral (n=934) groups. Demographics were balanced between femoral vs nonfemoral groups. Patients in the femoral group had significantly higher mean lead dwell times (11.6±9.7vs 6.6±6.6 years, P<.001), mean number of leads extracted (2.7±1.3vs 2.0±1.0, P<.001), 30-day procedure related major complications (including deaths) (8.5%vs 1.1%, P<.001) and emergency thoracotomy rates (4.2%vs 0.7%, P=.007). All-cause 30-day mortality rates were similar between groups (3.4%vs 2.0%, P=.315). Prolonged lead dwell time and increased number of leads extracted were predictive of a bailout transfemoral approach at multivariable analysis. Femoral approach TLE is associated with increased risk of 30-day procedure related major complications but not 30-day all-cause mortality. Prolonged lead dwell time and increased number of leads extracted are independent predictors for bailout transfemoral lead extraction. Such patients should be considered high risk of major complications and performed by high-volume lead extraction centers with experience in multiple approaches and techniques including experience with transfemoral lead extraction.

Risk Factors Associated with Venous Thromboembolism after Lung Cancer Surgery: A Single-center Study

背景与目的肺癌术后静脉血栓栓塞症（venous thromboembolism, VTE）的发生率并非少见，本研究旨在分析肺癌术后VTE相关危险因素，为进一步防治VTE提供临床依据。方法本研究为单中心研究。选择2016年7月-2017年12月在首都医科大学附属北京朝阳医院胸外科接受手术治疗的肺癌患者，除术前常规检查外，所有患者均在手术前后行下肢多普勒超声以明确有无新发下肢深静脉血栓（deep venous thrombosis, DVT）。患者术前术后均未接受预防性抗凝治疗。按照术后是否发生VTE将患者分为VTE组和对照组，比较两组间的基线资料、手术相关资料（手术类型、术式等）、肿瘤病理相关资料（病理分型、血管浸润、病理分期等）。结果按照纳入标准，本研究共对339例接受肺癌手术的患者进行了分析，其中男性166例，女性173例，年龄范围23岁-86岁。术后共39例发生VTE，发生率为11.5%。比较两组年龄、性别、体质量指数（body mass index, BMI）、美国麻醉医师协会（American Society of Anesthesiologists, ASA）、吸烟状况、基础疾病等，除年龄有显著性差异外，其他指标均无显著性差异；比较两组术前血常规、血生化、凝血、肿瘤标记物、肺功能、下肢静脉超声等，术前癌胚抗原（carcinoembryonic antigen, CEA）水平、术前D-二聚体水平、肺功能水平及下肢肌间静脉扩张比率两组有显著性差异，其他指标均无显著性差异；比较两组手术时长、手术方式、出血量、病理类型、病理分期、血管侵犯等，手术时长、手术方式（开胸vs胸腔镜）、出血量等因素有统计学差异，其他指标均无显著性差异。单因素分析结果显示：VTE组在年龄、术前CEA水平、术前D-二聚体水平、肺功能水平、下肢肌间静脉扩张比率、开胸手术比率、手术时长、出血量均与对照组有显著差异（P < 0.05）。而病理分期、病理类型等因素与VTE发生无显著相关性。多因素Logistics回归分析显示，第1秒用力呼气量（forced expiratory volume in one second, FEV1）、手术方式、下肢肌间静脉扩张是肺癌术后合并VTE的独立危险因素（P < 0.05）。结论本研究结果提示患者FEV1、手术方式以及下肢肌间静脉扩张是肺癌术后合并VTE的独立危险因素。

Cardiac Injuries at Estonian Major Trauma Facilities: A 23-year Perspective.

Cardiac injuries are highly lethal lesions following trauma and most of the patients decease in pre-hospital settings. However, studies on cardiac trauma in Estonia are scarce. Thus, we set out to study cardiac injuries admitted to Estonian major trauma facilities during 23 years of Estonian independence. After the ethics review board approval, all consecutive patients with cardiac injuries per ICD-9 (861.0 and 861.1) and ICD-10 codes (S.26) admitted to the major trauma facilities between 1 January 1993 and 31 July 2016 were retrospectively reviewed. Cardiac contusions were excluded. Data collected included demographics, injury profile, and in-hospital outcomes. Primary outcome was mortality. Secondary outcomes were cardiac injury profile and hospital length of stay. During the study period, 37 patients were included. Mean age was 33.1 ± 12.0 years and 92% were male. Penetrating and blunt trauma accounted for 89% and 11% of the cases, respectively. Thoracotomy and sternotomy rates for cardiac repair were 80% and 20%, respectively. Most frequently injured cardiac chamber was left ventricle at 49% followed by right ventricle, right atrium, and left atrium at 34%, 17%, and 3% of the patients, respectively. Multi-chamber injury was observed at 5% of the cases. Overall hospital length of stay was 13.5 ± 16.7 days. Overall mortality was 22% (n = 8) with uniformly fatal outcomes following left atrial and multi-chamber injuries. Overall, 37 patients with cardiac injuries were hospitalized to national major trauma facilities during the 23-year study period. The overall in-hospital mortality was 22% comparing favorably with previous reports. Risk factors for mortality were initial Glasgow Coma Scale < 9, pre-hospital cardiopulmonary resuscitation, and alcohol intoxication.

Perioperative cytokine profile during lung surgery predicts patients at risk for postoperative complications-A prospective, clinical study.

BackgroundPostoperative complications after lung surgery are frequent, having a detrimental effect on patients’ further course. Complications may lead to an increased length of hospital stay and cause additional costs. Several risk factors have been identified but it is still difficult to predict contemporary which patients are at risk. We hypothesized that patients who show an increased inflammatory response at the time of wound closure and 24 hours after surgery are at risk of postoperative complications within 30 days after surgery.MethodsPostoperative complications (pulmonary, cardiac, neurological and renal) of 96 patients scheduled for lung surgery at the Medical Center–University of Freiburg were analyzed in this prospective, clinical study. Blood samples for cytokine analysis (Interleukin (IL)-6, IL-8, IL-10, Tumor necrosis factor [TNF]-α, IL-1ß and IL12p70) were taken before surgery, at wound closure and 24 hours after surgery. Cytokine levels of patients with and without postoperative complications were analyzed by Receiver operating characteristic (ROC) curve analysis. To adjust the results according to existing covariates a multivariate logistic regression analysis was conducted.ResultsThe complication and non-complication group differed significantly according to nicotine dependency, Angiotensin-receptor-II blocker medication, rate of thoracotomy and preoperative lung function. The intraoperative hemodynamic parameters and therapy did not differ between the groups. Twenty-nine patients (30%) developed postoperative complications within 30 days after surgery. Plasma concentrations of IL-6, IL-10 and IL-8 at the time of wound closure and 24 hours after surgery were higher in the complication group. Multivariate regression analysis on postoperative complications revealed an Odds ratio of 56 for patients with IL-6 and IL-8 levels above the 3rd quartile measured on the first postoperative day.ConclusionsPerioperative detection of increased plasma concentrations of inflammatory cytokines in lung surgery may be used in addition to other clinical predictors to identify patients at risk for postoperative complications.Trial registrationGerman Clinical Trials Register 00006961.

Use of an evidence-based algorithm for patients with traumatic hemothorax reduces need for additional interventions.

Concerted management of the traumatic hemothorax is ill-defined. Surgical management of specific hemothoraces may be beneficial. A comprehensive strategy to delineate appropriate patients for additional procedures does not exist. We developed an evidence-based algorithm for hemothorax management. We hypothesize that the use of this algorithm will decrease additional interventions. A pre-/post-study was performed on all patients admitted to our trauma service with traumatic hemothorax from August 2010 to September 2013. An evidence-based management algorithm was initiated for the management of retained hemothoraces. Patients with length of stay (LOS) less than 24 hours or admitted during an implementation phase were excluded. Study data included age, Injury Severity Score, Abbreviated Injury Scale chest, mechanism of injury, ventilator days, intensive care unit (ICU) LOS, total hospital LOS, and interventions required. Our primary outcome was number of patients requiring more than 1 intervention. Secondary outcomes were empyema rate, number of patients requiring specific additional interventions, 28-day ventilator-free days, 28-day ICU-free days, hospital LOS, all-cause 6-month readmission rate. Standard statistical analysis was performed for all data. Six hundred forty-two patients (326 pre and 316 post) met the study criteria. There were no demographic differences in either group. The number of patients requiring more than 1 intervention was significantly reduced (49 pre vs. 28 post, p = 0.02). Number of patients requiring VATS decreased (27 pre vs. 10 post, p < 0.01). Number of catheters placed by interventional radiology increased (2 pre vs. 10 post, p = 0.02). Intrapleural thrombolytic use, open thoracotomy, empyema, and 6-month readmission rates were unchanged. The "post" group more ventilator-free days (median, 23.9 vs. 22.5, p = 0.04), but ICU and hospital LOS were unchanged. Using an evidence-based hemothorax algorithm reduced the number of patients requiring additional interventions without increasing complication rates. Defined criteria for surgical intervention allows for more appropriate utilization of resources. Therapeutic study, level IV.

OPTIMIZATION OF INDICATIONS FOR THORACOSCOPY IN CHEST TRAUMA

Background. The terms for application of video-assisted endosurgical interventions appear rather often in the surgery of chest trauma. There is a certain need for clear selection and differentiation of indications and contraindications for performing thoracoscopy and other operations. Materials and methods. The 3-years’ experience of treatment of patients with blunt chest trauma and penetrating wounds is described in the article. There was prevalence of patients with isolated blunt chest trauma (35.1%) and penetrating thoracic wounds (29.0%). We have performed thoracoscopy for 107 patients. Emergency thoracoscopy had been done in 38 cases (35.5%), urgent thoracoscopy in 27 (25.2%) and delayed thoracoscopy - in 42 patients (39.3%). The rate of thoracotomy was 14.9%. Results and discussion. The indications for thoracoscopy at chest trauma were defined. The analysis of treatment results depending on the kind of traumatic lesion and operation method was carried out. The best results were obtained in patients with isolated blunt chest trauma and those who underwent thoracoscopy. The role of thoracoscopy in case of urgent and delayed indications for surgery was emphasized. We registered complications in 13.5% of patients with blunt chest trauma and 6.1% of patients with penetrating wounds. The general mortality was 3.8%. Conclusion. We can conclude that the results of treatment of patients with blunt chest trauma and penetrating wounds depend on the severity of the trauma, terms and quality of special medical management and wide application of thoracoscopy.