Leonardi Beatrice, Sagnelli Caterina, Fiorelli Alfonso, Leone Francesco, Mirra Rosa, Pica Davide Gerardo, Di Filippo Vincenzo, Capasso Francesca, Messina Gaetana, Vicidomini Giovanni, Sica Antonello, Santini Mario
Department of Thoracic Surgery, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
Healthcare (Basel). 2022 Mar 28;10(4):635. doi: 10.3390/healthcare10040635.
Enhanced recovery after surgery protocols have shown improved clinical outcomes after lung resection surgery, but their application after empyema surgery is still limited. We retrospectively evaluated the outcomes of an adapted enhanced recovery after surgery (ERAS) protocol for immunocompromised patients who underwent video-assisted thoracoscopic surgery (VATS) surgery for chronic empyema between December 2013 and December 2021. The patients were divided into an ERAS group and a conventional treatment group. Peri-operative data were collected and compared between the two groups. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative pain and post-operative complications (air leaks, atelectasis). A total of 86 patients, 45 in the ERAS group and 41 in the non-ERAS group, were considered. Chest tube duration (6.4 ± 2.3 vs. 13.6 ± 6.8 days) and post-operative length of stay (7.6 ± 1.6 vs. 16.9 ± 6.9 days) were significantly shorter in the ERAS group. The volume of chest drainage (103 ± 78 vs. 157 ± 89 mL/day) was significantly smaller in the ERAS group. There were no significant differences in operative time, blood loss, need for transfusion, tube reinsertion and median VAS score. The incidence of air leaks and atelectasis was significantly reduced in the ERAS group, as was the need for bronchoscopic aspiration. The application of an ERAS protocol after empyema VATS surgery for immunocompromised patients improved the surgical outcome, reducing the post-operative length of stay and rate of complications.
术后加速康复方案已显示出在肺切除手术后能改善临床结局，但它们在脓胸手术后的应用仍然有限。我们回顾性评估了2013年12月至2021年12月期间因慢性脓胸接受电视辅助胸腔镜手术（VATS）的免疫功能低下患者采用改良术后加速康复（ERAS）方案的结局。患者被分为ERAS组和传统治疗组。收集并比较两组的围手术期数据。主要结局是术后住院时间。次要结局是术后疼痛和术后并发症（气胸、肺不张）。共纳入86例患者，ERAS组45例，非ERAS组41例。ERAS组的胸管留置时间（6.4±2.3天对13.6±6.8天）和术后住院时间（7.6±1.6天对16.9±6.9天）明显更短。ERAS组的胸腔引流量（103±78对157±89 mL/天）明显更少。手术时间、失血量、输血需求、再次置管和VAS评分中位数无显著差异。ERAS组的气胸和肺不张发生率以及支气管镜吸引需求均显著降低。免疫功能低下患者脓胸VATS手术后应用ERAS方案改善了手术结局，缩短了术后住院时间并降低了并发症发生率。
