Jacobsen Kristina, Talbert Steven, Boyer Joseph H
Division of Cardiothoracic Surgery, AdventHealth, Orlando, FL, USA.
UCF College of Nursing, University of Central Florida, Orlando, FL, USA.
J Thorac Dis. 2019 Dec;11(12):5328-5335. doi: 10.21037/jtd.2019.11.69.
Postoperative air leaks are the most common complication after a pulmonary resection. There is no data in the literature comparing the traditional and digital chest drainage system after a robotic-assisted pulmonary lobectomy.
This was a retrospective, correlational study. Medical records from 182 eligible robotic-assisted lobectomy patients were evaluated to determine the association between digital and traditional chest tube drainage systems (CTDS) with postoperative chest tube days, hospital LOS, chest tube reinsertion during hospitalization, and 30-day readmission for pneumothorax. Multiple regression was used to determine the association between CTDS while controlling for confounding variables.
No differences were noted between groups for age, gender, BMI, smoking, adhesions or neoadjuvant therapy. Patients with digital drainage systems had significantly shorter chest tube duration than those with traditional drainage systems (2.07 2.73 days, P=0.003). After controlling for age and BMI, CTDS was not found to be a significant predictor of CT duration. Digital drainage system were also associated with significantly shorter hospital LOS (4.02 5.06 days, P=0.01) After controlling for age, BMI, and presence of post-op a-fib, use of a digital CTDS was significantly associated with 1 day shorter hospital LOS. Chest tube reinsertion occurred four times more frequently with traditional drainage systems, but the difference did not achieve the level of statistical significance (P=0.059). The frequency of readmission due to pneumothorax was very low (1 patient per group), which prevented comparative statistical analysis.
In the digital drainage system there are shorter chest tube days and hospital length of stay after a robotic-assisted lobectomy. The decision to remove chest tubes in the traditional drainage system is burdened with uncertainty. The digital drainage system reduces intraobserver variability allowing for improved decision making in chest tube removal. Both CT duration and hospital LOS were shorter using unadjusted analyses. Type of CTDS was not significantly associated with CT duration after controlling for age and BMI. However, after controlling for age, BMI, and post-op atrial fibrillation, use of the digital CTDS was associated with a 1 day reduction in hospital LOS.
术后漏气是肺切除术后最常见的并发症。文献中没有关于机器人辅助肺叶切除术后传统胸腔引流系统与数字胸腔引流系统比较的数据。
这是一项回顾性相关性研究。对182例符合条件的机器人辅助肺叶切除患者的病历进行评估，以确定数字胸腔引流系统和传统胸腔引流系统（CTDS）与术后胸腔引流天数、住院时间、住院期间胸腔引流管重新插入以及气胸30天再入院之间的关联。使用多元回归来确定CTDS之间的关联，同时控制混杂变量。
两组在年龄、性别、BMI、吸烟、粘连或新辅助治疗方面没有差异。使用数字引流系统的患者胸腔引流管留置时间明显短于使用传统引流系统的患者（2.07比2.73天，P = 0.003）。在控制年龄和BMI后，未发现CTDS是CT持续时间的显著预测因素。数字引流系统还与明显更短的住院时间相关（4.02比5.06天，P = 0.01）。在控制年龄、BMI和术后房颤的存在后，使用数字CTDS与住院时间缩短1天显著相关。传统引流系统胸腔引流管重新插入的频率高出四倍，但差异未达到统计学意义水平（P = 0.059）。因气胸再入院的频率非常低（每组1例患者），这妨碍了比较统计分析。
在机器人辅助肺叶切除术后，数字引流系统的胸腔引流天数和住院时间更短。传统引流系统中拔除胸腔引流管的决定存在不确定性。数字引流系统减少了观察者间的变异性，有助于在拔除胸腔引流管时做出更好的决策。未经调整的分析显示CT持续时间和住院时间都更短。在控制年龄和BMI后，CTDS类型与CT持续时间无显著关联。然而，在控制年龄、BMI和术后房颤后，使用数字CTDS与住院时间缩短1天相关。
