Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States.
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
Thorac Cardiovasc Surg. 2022 Aug;70(5):422-429. doi: 10.1055/s-0041-1740322. Epub 2021 Dec 11.
Chest drains are placed following pulmonary resection to promote lung re-expansion. The superiority of two chest drains at preventing postoperative complications has not been established, and practice remains largely dictated by surgeon preference. We sought to compare patient outcomes based on number of chest drains used.
This is a retrospective analysis including patients undergoing lobectomies and segmentectomies between March 2016 and April 2020. Patients were categorized based on number of chest drains placed and were matched 1:1 using the nearest neighbor (greedy) technique. Our primary outcome was opioid prescriptions at discharge (in morphine equivalent daily dose [MEDD]). Associations were tested using multilevel mixed-effects regression to account for variability between surgeons.
A total of 1,094 patients met inclusion criteria. Single chest drain was used in 922 patients, whereas 172 had two chest tubes. After matching, there were 111 patients in each group. In multilevel mixed-effects logistic regression, patients treated with a single chest drain received fewer opioid prescriptions (: -194 MEDD, 95% confidence interval [CI]: -302 to -86 MEDD, < 0.01), were more likely to be opioid-free at hospital discharge (odds ratio [OR] = 2.11, 95% CI: 1.08-4.12, = 0.03), and had lower readmission rates within 30 days (OR = 0.33, 95% CI: 0.13-0.84, = 0.02). Single chest drain practice did not affect the risk of pulmonary complications and there was no statistically significant difference in length of hospital stay (3 days [interquartile range: 2-5] vs. 4 days [3-6], = 0.08).
Single chest drain practice in lobectomies and segmentectomies was associated with less opioid prescription requirement without any increase in complications.
放置胸腔引流管是为了促进肺复张，这是在肺切除术后进行的。两种胸腔引流管在预防术后并发症方面的优势尚未得到证实，实践仍然主要取决于外科医生的偏好。我们试图根据使用的胸腔引流管数量比较患者的结局。
这是一项回顾性分析，纳入了 2016 年 3 月至 2020 年 4 月期间接受肺叶切除术和肺段切除术的患者。患者根据放置的胸腔引流管数量进行分类，并使用最近邻（贪婪）技术进行 1:1 匹配。我们的主要结局是出院时的阿片类药物处方（以等效吗啡日剂量[MEDD]表示）。使用多级混合效应回归来测试关联，以考虑外科医生之间的变异性。
共有 1094 名患者符合纳入标准。922 名患者使用单根胸腔引流管，172 名患者使用两根胸腔引流管。匹配后，每组各有 111 名患者。在多级混合效应逻辑回归中，使用单根胸腔引流管的患者接受的阿片类药物处方较少（-194 MEDD，95%置信区间[CI]：-302 至-86 MEDD， < 0.01），出院时更有可能无阿片类药物（优势比[OR] = 2.11，95%CI：1.08-4.12， = 0.03），30 天内再入院率较低（OR = 0.33，95%CI：0.13-0.84， = 0.02）。单根胸腔引流管的使用并未增加肺部并发症的风险，且住院时间无统计学差异（3 天[四分位距：2-5] vs. 4 天[3-6]， = 0.08）。
肺叶切除术和肺段切除术中单根胸腔引流管的使用与减少阿片类药物处方需求相关，而不会增加并发症。
