49 - Freie Mitteilung
Clinical works II
16. Mai 2019, 10:15 - 11:45, Bellavista 2, 6. OG
Outcomes of patients discharged home with a chest tube following Anatomical Lung Resection: A multicenter Cohort Study
F. Minervini1, W. C. Hanna2, A. Brunelli3, F. Farrokhyar2, T. Miyazaki3, L. Bertolaccini4, M. Scarci5, M. Coret2, K. Hughes2, L. Schneider2, Y. Lopez-Hernandez2, J. Agzarian2, C. Finley2, Y. Shargall2, Presenter: F. Minervini1 (1Luzern, 2Hamilton/CA, 3Leeds/UK, 4Bologna/IT, 5Monza/IT)
Prolonged air leak following lung resections remains a common postoperative complication. With more minimally invasive resections and earlier hospital discharges, more patients are expected to be discharged home with a chest tube. We evaluated the outcomes of those patients and potential risk factors associated with adverse outcomes.
Retrospective analysis of prospectively collected data from four tertiary academic centers between 1.2014 and 12.2017. Missing post-discharge data were completed via phone call to patients and their family physicians. Data was analyzed for 253 patients, representing 9.0% of all patients undergoing anatomical lung resections during that period. Chi-square and Mann-Whitney U tests were used to asses for patients and operative parameters associated with outcomes post discharge. Logistic regression was performed to evaluate factors associated with risk of empyema development and need for readmissions and intervention.
Of 253 patients analyzed, there were 67/857 patients from center A(7.8%) , 30/759 from center B(3.95%), 147/931 from center C (15.78%), and 9/247 from center D(3.64%)(p<0.001). Median age was 69(19-88), 56% males. Overall, 49 patients (19.4%) were readmitted (21%, 0%, 23%, 11%, centers A-D, respectively, p=0.029) and analyzed. Of those, 18(37%) developed empyema, 11(22%) required surgery and 3(6%) died. Median LOS was 8(3-63) and 7(3-30) days for readmitted vs not-readmitted patients (p=0.588). Comorbidities (p=0.1-0.9), approach (MIS vs thoracotomy, p=0.75) and extent of resection (p=0.577) were not associated with risk of readmissions. Median overall initial duration of chest tube was 22 days (4-141) for readmitted patients vs 16(1-148) days for not readmitted (p<0.001). Duration of chest tube stay was the only factor associated with development of empyema (p=0.003). The risk of empyema increased 3-fold (OR=2.94) when chest tube was left in-situ for more than 20 days
Home discharge with a chest tube following lung resection is associated with significant adverse events. Given high risk of empyema development, removal of chest tube should be considered, when appropriate, after 20 days. Our data suggests potential need for active post-discharge outpatients program, in order to diminish subsequent risk of morbidity and mortality