Jessica M Mayor1, Donald R Lazarus2, Roberto F Casal3, Shuab Omer1, Ourania Preventza4, Katherine Simpson1, Ernesto Jimenez1, Lorraine D Cornwell5. 1. Department of Surgery, Baylor College of Medicine, Houston, Texas. 2. Department of Medicine, Baylor College of Medicine, Houston, Texas. 3. Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, Texas. 4. Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. 5. Department of Surgery, Baylor College of Medicine, Houston, Texas. Electronic address: cornwell@bcm.edu.
Abstract
BACKGROUND: Air leaks can impede recovery from lung resection. To help prevent and manage air leaks, we developed a comprehensive program that includes using precompression of lung staple lines, sealant, fissureless video-assisted thoracoscopic (VATS) lobectomy, a digital drainage system, and endobronchial valve placement for prolonged air leak. We assessed the effectiveness of this program on air leak duration, hospital length of stay (LOS), and chest tube duration in our high-risk veteran population. METHODS: Using a prospectively maintained database, we retrospectively analyzed data from 226 patients who underwent lung resection for cancer by VATS lobectomy in a Veterans Affairs center. Patients were divided into two groups. Group A (n = 134; historical controls) underwent lobectomy from July 2009 through October 2013; group B (n = 92; intervention group) underwent lobectomy from November 2013 through July 2016 and received care per the comprehensive program. RESULTS: The median hospital LOS was significantly shorter in group B than in group A patients (5 days versus 6 days, respectively; p = 0.0001). Group B had a shorter median chest tube duration (2 days versus 3 days, p = 0.027). Prolonged air leak (more than 5 days) occurred in 5.4% of group B and 9.7% of group A patients (p = 0.24). Prolonged LOS (more than 14 days) was less frequent in group B (1.1%) than in group A (8.2%, p = 0.030). Multivariable analysis showed that predictors of decreased air leak duration, chest tube duration, and LOS included undergoing surgery in the later period (group B). CONCLUSIONS: Our comprehensive program was associated with reduced chest tube days and hospital LOS.
BACKGROUND: Air leaks can impede recovery from lung resection. To help prevent and manage air leaks, we developed a comprehensive program that includes using precompression of lung staple lines, sealant, fissureless video-assisted thoracoscopic (VATS) lobectomy, a digital drainage system, and endobronchial valve placement for prolonged air leak. We assessed the effectiveness of this program on air leak duration, hospital length of stay (LOS), and chest tube duration in our high-risk veteran population. METHODS: Using a prospectively maintained database, we retrospectively analyzed data from 226 patients who underwent lung resection for cancer by VATS lobectomy in a Veterans Affairs center. Patients were divided into two groups. Group A (n = 134; historical controls) underwent lobectomy from July 2009 through October 2013; group B (n = 92; intervention group) underwent lobectomy from November 2013 through July 2016 and received care per the comprehensive program. RESULTS: The median hospital LOS was significantly shorter in group B than in group A patients (5 days versus 6 days, respectively; p = 0.0001). Group B had a shorter median chest tube duration (2 days versus 3 days, p = 0.027). Prolonged air leak (more than 5 days) occurred in 5.4% of group B and 9.7% of group A patients (p = 0.24). Prolonged LOS (more than 14 days) was less frequent in group B (1.1%) than in group A (8.2%, p = 0.030). Multivariable analysis showed that predictors of decreased air leak duration, chest tube duration, and LOS included undergoing surgery in the later period (group B). CONCLUSIONS: Our comprehensive program was associated with reduced chest tube days and hospital LOS.