Department of Thoracic Surgery, University Hospital Southampton, Southampton, UK.
University of Southampton Medical School, University of Southampton, Southampton, UK.
Gen Thorac Cardiovasc Surg. 2023 Mar;71(3):182-188. doi: 10.1007/s11748-022-01873-9. Epub 2022 Oct 10.
To demonstrate the safety and feasibility of advanced nurse practitioner-led (ANP-led) outpatient follow-up after discharge with ambulatory chest drains for prolonged air leak and excessive fluid drainage.
Patients discharged with ambulatory chest drains between January 2017 and December 2019 were retrospectively reviewed. Discharge criteria included air leak < 200 ml/min or fluid drainage > 100 ml/24 h on a digital drain. Patients were reviewed weekly in the clinic by ANPs, a highly skilled cohort of nurses with physician support available. Outcomes included length of stay, duration of air or fluid leak and complications.
Two-hundred patients were included, amounting to 368 clinic episodes. The median age was 68 ± 13 years and 119 (60%) were male. 112 (56%) patients underwent anatomical lung resection (total anatomical lung resections during the study period = 917) equating to a discharge with ambulatory chest drain rate of 12.2% in this group. The median length of stay was 6 ± 3 days and 176 (88%) patients were discharged with air leak versus 24 (12%) with excessive fluid drainage. The median time to drain removal was 12 ± 11 days. Complications occurred in 16 patients (8%) and 12 (6%) required readmission. An estimated 2075 inpatient days were saved over the study period equating to an annual cost saving of £123,167 (US$149,032) per annum.
Patients with air leak or excessive fluid drainage can safely be discharged with ambulatory chest drains, allowing them to return to their familiar home environment safely and quickly. ANP-led clinics are a robust and cost-effective follow-up strategy and are associated with a low complication rate.
展示高级执业护士主导（ANP 主导）的门诊随访在出院后使用可携带胸腔引流管治疗持续性气胸和过多液体引流的安全性和可行性。
回顾性分析 2017 年 1 月至 2019 年 12 月期间出院并携带可携带胸腔引流管的患者。出院标准包括气胸漏出率<200ml/min 或液体引流>100ml/24h 时数字引流。由 ANP 每周在诊所对患者进行检查，ANP 是具有医生支持的高技能护士群体。结果包括住院时间、气胸或液体漏出持续时间和并发症。
共纳入 200 例患者，共 368 例门诊随访。患者的中位年龄为 68±13 岁，119 例（60%）为男性。112 例（56%）患者接受了解剖性肺切除术（研究期间共进行了 917 例解剖性全肺切除术），这组患者出院时携带可携带胸腔引流管的比例为 12.2%。中位住院时间为 6±3 天，176 例（88%）患者出院时存在气胸漏出，24 例（12%）患者存在过多液体引流。中位引流管拔除时间为 12±11 天。16 例（8%）患者发生并发症，12 例（6%）需要再次入院。在研究期间，估计节省了 2075 个住院日，相当于每年节省 123167 英镑（149032 美元）。
有气胸或过多液体引流的患者可安全出院携带可携带胸腔引流管，使其能够安全快速地返回家中熟悉的环境。由 ANP 主导的门诊随访是一种可靠且具有成本效益的随访策略，并发症发生率较低。
