McCormack Ashley J, El Zaeedi Mohamed, Geraci Travis C, Cerfolio Robert J
Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY.
JTCVS Open. 2023 Sep 26;16:909-915. doi: 10.1016/j.xjon.2023.09.028. eCollection 2023 Dec.
Chest tubes cause pain and morbidity.
This is a quality initiative study and review of patients who underwent robotic pulmonary resection by 1 surgeon (R.J.C.). The goal was to remove chest tubes within 4 to 12 hours after robotic segmentectomy and lobectomy. Primary outcome was removal without the need for reinsertion, thoracentesis, or any morbidity due to early removal of the chest tube. Secondary outcomes were symptomatic pneumothorax, pleural effusion, chylothorax, subcutaneous emphysema, and chest tube reinsertion or thoracentesis within 60 days of surgery.
Between January 2018 and December 2022, 590 patients underwent robotic lobectomy or segmentectomy. Chest tubes were removed within 4 to 12 hours postoperatively in 63.5% of patients (375/590). In 2022, this was achieved in 91% after lobectomy (119/128) and 94% after segmentectomy (75/80). There were significantly more chest tubes removed within 4 to 12 hours postoperatively from 2020 to 2022 than pre-2020 ( < .001). Forty patients (6.8%) were discharged home on postoperative day 1 with a chest tube. Sixteen patients (2.7%) had post-chest tube removal increasing pneumothorax and subcutaneous emphysema; none required tube reinsertion. There was no 30-day or 90-day mortality. Twelve patients (2%) had an outpatient thoracentesis for effusion within 60 days. Twenty patients (3.3%) were readmitted, none seemingly related to effusions. Nonsmokers ( = .04) and segmentectomy ( = .001) were associated with chest tube removal within 4 to 12 hours of surgery.
Chest tubes can be safely removed within 4 to 12 hours after robotic segmentectomy and lobectomy. Factors associated with successful early chest tube removal are nonsmoking, segmentectomy, and team members becoming comfortable with the process.
胸管会引起疼痛和并发症。
这是一项对由1名外科医生（R.J.C.）实施机器人辅助肺切除术的患者进行的质量改进研究及回顾。目标是在机器人辅助肺段切除术和肺叶切除术后4至12小时内拔除胸管。主要结局是无需重新插入胸管、胸腔穿刺或因过早拔除胸管导致任何并发症即可拔除胸管。次要结局是有症状的气胸、胸腔积液、乳糜胸、皮下气肿以及术后60天内胸管重新插入或胸腔穿刺。
2018年1月至2022年12月期间，590例患者接受了机器人辅助肺叶切除术或肺段切除术。63.5%的患者（375/590）在术后4至12小时内拔除了胸管。2022年，肺叶切除术后91%（119/128）、肺段切除术后94%（75/80）实现了这一目标。2020年至2022年术后4至12小时内拔除的胸管明显多于2020年之前（<0.001）。40例患者（6.8%）术后第1天带胸管出院回家。16例患者（2.7%）胸管拔除后气胸和皮下气肿加重；均无需重新插入胸管。无30天或90天死亡率。12例患者（2%）在60天内门诊行胸腔穿刺引流胸腔积液。20例患者（3.3%）再次入院，似乎均与胸腔积液无关。非吸烟者（=0.04）和肺段切除术（=0.001）与手术4至12小时内拔除胸管相关。
机器人辅助肺段切除术和肺叶切除术后4至12小时内可安全拔除胸管。与早期成功拔除胸管相关的因素包括不吸烟、肺段切除术以及团队成员对该过程逐渐熟练。
