Brookes John D L, Williams Michael, Mathew Manish, Yan Tristan, Bannon Paul
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.
Sydney Medical School, The University of Sydney, New South Wales, Australia.
J Thorac Dis. 2021 Feb;13(2):1083-1089. doi: 10.21037/jtd-20-2082.
One of the most frequent complications of coronary artery bypass grafting (CABG) is pleural effusion. Limited previous studies have found post-CABG pleural effusion to be associated with increased length-of-stay and greater morbidity post-CABG. Despite this the associations of this common complication are poorly described. This study sought to identify modifiable risk factors for effusion post-CABG.
A retrospective cohort study of prospectively collected data assessed patients who underwent CABG over two-years. Data was collected for risk factors and sequelae related to pleural effusion requiring drainage.
A total of 409 patients were included. Average age was 64.9±10.2 years, 330 (80.7%) were male. 59 (14.4%) patients underwent drainage of pleural effusion post-CABG. Effusions were drained on average 9.9±8.4 days post-CABG. Earlier removal of drain tubes and removal near time of extubation were associated with development of pleural effusion. Post-CABG pleural effusion was associated with post-operative renal impairment (P<0.01) and pericardial effusion (P<0.01). Patients with pleural effusion were more likely to require readmission to ICU (P<0.01), reintubation (P=0.03) and readmission to hospital (P=0.03).
Pleural effusion is a common complication of cardiac surgery and is associated with significant morbidity and resource utilization. This study identifies several associated complications that should be considered in the presence of pleural effusion. Modifiable associated factors in the management of drains that may contribute to accumulation of pleural effusion include: early removal of chest drains, higher outputs and removal during or close to mechanical ventilation. Further research is required to assess how adjusting these modifiable factors can decrease rates of effusion post-operatively.
冠状动脉旁路移植术（CABG）最常见的并发症之一是胸腔积液。既往有限的研究发现，CABG术后胸腔积液与住院时间延长及CABG术后更高的发病率相关。尽管如此，这种常见并发症的相关因素仍描述甚少。本研究旨在确定CABG术后胸腔积液的可改变危险因素。
一项对前瞻性收集数据的回顾性队列研究，评估了两年内接受CABG的患者。收集了与需要引流的胸腔积液相关的危险因素和后遗症的数据。
共纳入409例患者。平均年龄为64.9±10.2岁，330例（80.7%）为男性。59例（14.4%）患者在CABG术后进行了胸腔积液引流。胸腔积液平均在CABG术后9.9±8.4天进行引流。引流管拔除过早以及在拔管时或接近拔管时拔除与胸腔积液的发生相关。CABG术后胸腔积液与术后肾功能损害（P<0.01）和心包积液（P<0.01）相关。胸腔积液患者更有可能需要再次入住重症监护病房（P<0.01）、再次插管（P=0.03）和再次入院（P=0.03）。
胸腔积液是心脏手术的常见并发症，与显著的发病率和资源利用相关。本研究确定了在出现胸腔积液时应考虑的几种相关并发症。在引流管理中可能导致胸腔积液积聚的可改变相关因素包括：胸腔引流管拔除过早、引流量较高以及在机械通气期间或接近机械通气时拔除。需要进一步研究以评估调整这些可改变因素如何能降低术后胸腔积液的发生率。
