Cardiothoracic Surgery |

Assessment of Intraoperative Techniques to Minimize the Impact of Pleural Air Leaks for Pulmonary Resection FREE TO VIEW

Zach Richardson, BS; Juan Saucedo, BA; Christopher Wigfield, MD
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Loyola University Medical Center, Maywood, IL

Chest. 2013;144(4_MeetingAbstracts):115A. doi:10.1378/chest.1704016
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SESSION TITLE: Cardiac and Thoracic Surgery Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Postoperative pleural or bronchial air leaks frequently complicate pulmonary resections. While many reseal with expectant management, prolonged leaks are associated with morbidity. Persisting >7 days they increase healthcare costs and delay return to productivity. Traditional intraoperative techniques include sutures, stapling-devices, pleurodesis, and surface sealants/glues. This study describes the comparative efficacy of intraoperative modalities.

METHODS: A review of all pulmonary resections at a single center was performed. Methods of air leak treatment were categorized and the EMR database was analyzed. The cohort included all thoracotomies between 2007-2012. Presence and length of postoperative air leaks, chest tube duration, and length of hospital stay were established. We determined the overall efficacy of contributing factors with a focus on utility of techniques.

RESULTS: Of 432 patients assessed, 310 (183 male, 127 female) had complete data sets. 119 (37.7%) patients had postoperative air leaks, 77.3% of which resolved with conservative management within 7 days. 8.7% of all patients had prolonged postoperative air leaks. Four techniques (sutures, stapling, glues/sealants, and pleurodesis) proved equally effective in preempting postoperative air leaks. No mortality within 30 days due to postoperative air leaks. Cases without specific modalities used had a median hospital stay of 9 days. Utilization of intraoperative techniques reduced median hospital stay by 2 days.

CONCLUSIONS: Our findings confirm that no single intra-operative technique may be considered superior, but the employment of even one approach has a strong impact on outcomes. Decreased hospital stay suggests that the cost of routinely utilizing intraoperative techniques would likely be offset.

CLINICAL IMPLICATIONS: Regardless of whether an air leak is visible, the use of even one intraoperative technique aimed at reducing the chance of a postoperative air leak from occurring can have a significant positive impact on patient outcome.

DISCLOSURE: The following authors have nothing to disclose: Zach Richardson, Juan Saucedo, Christopher Wigfield

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