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J Thorac Cardiovasc Surg 1998;115:319-327
© 1998 Mosby, Inc.
GENERAL THORACIC SURGERY |
From the Division of Cardiovascular and Thoracic Surgery, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, Fla.
Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4-7, 1997.
Received for publication May 7, 1997; revisions requested July 15, 1997; revisions received Oct. 7, 1997; accepted for publication Oct. 7, 1997. Address for reprints: Lary A. Robinson, MD, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL 33612-9497.
Objective: A prolonged air leak after an upper lobectomy is a major determinant of morbidity and hospital stay. Creation of a pleural tent after upper lobectomy was used to investigate whether obliterating the usual postoperative intrapleural apical space with the parietal pleura would help shorten chest tube time.
Methods: From August, 1994, through January, 1997, 48 consecutive patients undergoing an isolated upper lobectomy for a neoplasm were reviewed. Twenty-eight patients had creation of a pleural tent and 20 patients did not. Demographic and clinical profiles of both groups were not significantly different. Chest tubes were removed when there was no air leak for 48 hours and chest tube drainage was less than 75 ml per 8 hours.
Results: The tented patients had significantly shorter mean air leak (tented 1.6 ± 0.3 days vs nontented 3.9 ± 1.2 days, p = 0.04), mean chest tube total drainage (tented 1619.5 ± 95.5 ml vs nontented 2476.3 ± 346.4 ml, p = 0.009), mean chest tube duration (tented 4.0 ± 0.2 days vs nontented 6.6 ± 1.0 days, p = 0.004), mean total hospitalization time (tented 6.4 ± 0.4 days vs nontented 8.6 ± 1.0 days, p = 0.02). No operative deaths occurred. Morbidity was not significantly different between groups.
Conclusions: (1) Creation of a pleural tent at the time of upper lobectomy appears to significantly reduce chest tube time and shorten hospitalization. (2) No morbidity or mortality was associated with this simple, quick procedure. (3) Surgeons should consider creation of a pleural tent at the time of upper lobectomy.
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