Safety of Outpatient Chest Tube Management of Air Leaks after Pulmonary Resection

2015 ◽  
Vol 81 (8) ◽  
pp. 760-763 ◽  
Author(s):  
Anna M. Royer ◽  
Jeremy S. Smith ◽  
Ashley Miller ◽  
Marlana Spiva ◽  
Jenny M. Holcombe ◽  
...  
Keyword(s):  
Chest Tube ◽  
Pulmonary Resection ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Mortality Data ◽  
Patient Demographics ◽  
Air Leaks ◽  
Water Seal ◽  
Hospital Days ◽  
Discharge Criteria

Prolonged air leaks are the most common postoperative complication following pulmonary resection, leading to increased hospital length of stay (LOS) and cost. This study assesses the safety of discharging patients home with a chest tube (CT) after pulmonary resection. A retrospective review was performed of a single surgeon's experience with pulmonary resections from January 2010 to January 2015. All patients discharged home with a CT were included. Discharge criteria included a persistent air leak controlled by water seal, resolution of medical conditions requiring hospitalization, and pain managed by oral analgesics. Patient demographics, type of resection, LOS, and 30-day morbidity and mortality data were analyzed. Comparisons were made with the Society of Thoracic Surgery database January 2011 to December 2013. Four hundred ninety-six patients underwent pulmonary resection. Sixty-five patients (13%) were discharged home postoperatively with a CT. Fifty-eight patients underwent a lobectomy, two patients a bilobectomy, and five patients had a wedge excision. Two patients were readmitted: One with a lower extremity deep venous thrombosis and the other with a nonlife threatening pulmonary embolus. Four patients developed superficial CT site infections that resolved after oral antibiotics. Patients discharged home with a CT following lobectomy had a shorter mean LOS compared to lobectomy patients (3.65 vs 6.2 days). Mean time to CT removal after discharge was 4.7 days (range 1–22 days) potentially saving 305 inpatient hospital days. Select patients can be discharged home with a CT with reduced postoperative LOS and without increase in major morbidity or mortality.

Initial Chest Tube Management after Pulmonary Resection

2005 ◽  
Vol 71 (5) ◽  
pp. 416-419 ◽  
Author(s):  
G. Antanavicius ◽  
J. Lamb ◽  
P. Papasavas ◽  
P. Caushaj
Keyword(s):  
Hospital Stay ◽  
Chest Tube ◽  
Pulmonary Resection ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Tube Thoracostomy ◽  
Hospital Length Of Stay ◽  
Air Leak ◽  
Chest Tubes ◽  
Water Seal

Tube thoracostomy management with suction or water seal after anatomical pulmonary resection remains somewhat controversial. Initial chest tube management may influence the duration of pleural fluid drainage, duration of tube thoracostomy, and/or hospital length of stay following pulmonary resection. We hypothesized that initial chest tube management with water seal decreases time for chest tube removal and decreases time of hospital stay. A retrospective chart review was performed on 109 consecutive patients who underwent lobectomy or segmentectomy in Western Pennsylvania Hospital between December 1999 and December 2003. Comparison was made between chest tube management of water seal or suction in patients with and without air leak. Of the 109 patients, 78 (72%) had no air leak at the completion of surgery, and 31 (28%) had air leak. In the group without air leak (n = 78), water seal was used in 32 (41%) patients and suction in 46 (59%). In patients placed to water seal initially after surgery (n = 32), removal of chest tubes was on postoperative day (POD) 3.19 ± 0.24 and hospital discharge was on POD 5.13 ± 0.61. In patients placed to suction initially (n = 46), chest tubes were removed on POD 4.52 ± 0.40. Hospital discharge was on POD 6.74 ± 0.5. Both duration of chest tube ( P < 0.007) and length of hospital stay ( P < 0.04) were significantly lower in the water seal group. In the air leak group (n = 31), 7 (23%) patients were managed with water seal and 24 (77%) patients with suction. Both duration of chest tube ( P = 0.001) and length of hospital stay ( P < 0.05) were significantly lower in the water seal group. In patients without air leak, chest tubes should be managed with water seal following anatomical pulmonary resection, resulting in significantly shorter chest tube duration and hospital length of stay.

scholarly journals 623. Self-Administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) in Uninsured Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S371-S371
Author(s):  
Yasir Hamad ◽  
Jaspur Min ◽  
Yvonne Burnett
Keyword(s):  
Antimicrobial Therapy ◽  
Adverse Drug Events ◽  
Hospital Length ◽  
Clinic Visit ◽  
Hospital Length Of Stay ◽  
Uninsured Patients ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Joint Infections ◽  
Insured Patients ◽  
Hospital Days

Abstract Background Uninsured patients requiring long-term intravenous (IV) antimicrobials do not have access to outpatient parenteral antimicrobial therapy (OPAT) and often remain hospitalized for the duration of their treatment, transition to inferior oral antimicrobials, or leave against medical advice. A hospital-supported self-administered OPAT (S-OPAT) program was piloted in uninsured patients to decrease hospital length of stay and improve access to care. Methods Uninsured adult patients requiring IV antimicrobials were enrolled in an S-OPAT pilot study from July 2019 to April 2020. Patients with drug use history or documented non-adherence were excluded. S-OPAT patients attended weekly clinic visits for blood draws, dressing changes, and medication supply. The measured outcomes were hospital days saved, and potential income generated by earlier discharges. The latter was calculated by multiplying the number of hospital days saved by the daily charge for a hospital bed to insured patients. Results Seventeen patients were enrolled in S-OPAT, 14 (82%) were males, 8 (47%) were black, and the mean age was 39 years. The most common indication for OPAT was bone and joint infections in 12 (71%), and most commonly used antibiotic was ceftriaxone in 12 (71%) patients (Table). Early discontinuation occurred in 3 (17%) patients due to clinic visit non-adherence resulted in 2 (12%) and adverse drug events in 1 (6%). Only one (6%) patient had unplanned hospital readmission during OPAT. Transition to S-OPAT resulted in 533 hospital days avoided, and a net saving of approximately $900,000. Conclusion S-OPAT model is safe and can enhance care for uninsured patients while optimizing health-system resources. Table Disclosures All Authors: No reported disclosures

scholarly journals Functional Adhesion of Pectin Biopolymers to the Lung Visceral Pleura

Polymers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 2976
Author(s):  
Yifan Zheng ◽  
Aidan F. Pierce ◽  
Willi L. Wagner ◽  
Hassan A. Khalil ◽  
Zi Chen ◽  
...  
Keyword(s):  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Citrus Pectin ◽  
Pressure Sensitive Adhesives ◽  
Air Leaks ◽  
Pulmonary Surgery ◽  
Pressure Sensitive ◽  
Pleural Surface ◽  
Pleural Abrasion ◽  
Lung Injuries

Pleural injuries and the associated “air leak” are the most common complications after pulmonary surgery. Air leaks are the primary reason for prolonged chest tube use and increased hospital length of stay. Pectin, a plant-derived heteropolysaccharide, has been shown to be an air-tight sealant of pulmonary air leaks. Here, we investigate the morphologic and mechanical properties of pectin adhesion to the visceral pleural surface of the lung. After the application of high-methoxyl citrus pectin films to the murine lung, we used scanning electron microscopy to demonstrate intimate binding to the lung surface. To quantitatively assess pectin adhesion to the pleural surface, we used a custom adhesion test with force, distance, and time recordings. These assays demonstrated that pectin–glycocalyceal tensile adhesive strength was greater than nanocellulose fiber films or pressure-sensitive adhesives (p < 0.001). Simultaneous videomicroscopy recordings demonstrated that pectin–glycocalyceal adhesion was also stronger than the submesothelial connective tissue as avulsed surface remnants were visualized on the separated pectin films. Finally, pleural abrasion and hyaluronidase enzyme digestion confirmed that pectin binding was dependent on the pleural glycocalyx (p < 0.001). The results indicate that high methoxyl citrus pectin is a promising sealant for the treatment of pleural lung injuries.

Computer-Mediated Power Stapling for Anatomical Lung Resection: Experience in 100 Consecutive Cases

2006 ◽  
Vol 1 (6) ◽  
pp. 328-331 ◽  
Author(s):  
Wickii T. Vigneswaran ◽  
Charles Gruner
Keyword(s):  
Length Of Stay ◽  
Chest Tube ◽  
Lung Resection ◽  
Hospital Length ◽  
Chest Tube Drainage ◽  
Hospital Length Of Stay ◽  
Tube Drainage ◽  
Computer Mediated ◽  
Linear Cutter ◽  
Lung Resections

Objectives Mechanical stapling is widely used for lung resection. Complications related to the stapling are few but not infrequent. This varies from complete disruption of the staples to incomplete sealing of vascular structures. A stapling platform that has a strong clamping force with precise and consistent staple formation suitable for thickness of tissue is likely to be an advance in existing devices and may reduce the complication rate. A new, computer-mediated power stapling is currently available for lung resections, with three types of digital loading units (DLU). Clinical data on its use are limited. We report our experience with this stapling platform (SurgASSIST) in our first 100 patients undergoing anatomic lung resection. Methods Fifty-four men and forty-six women (mean age, 64 ± 7 years) underwent anatomic lung resections, using a lateral, muscle-sparing mini-thoracotomy, during 2004 to 2005, with the SurgASSIST platform. Three types of DLUs were used for lung resection: a linear cutter, a right-angled vascular cutter, and a right-angled bronchial cutter. Observational data were collected prospectively on the operative procedure, type of staples used, duration of operation, chest tube drainage, and hospital length of stay. Results There were 83 lobectomies, 5 bilobectomies, 5 segmental resections, and 7 pneumonectomies. A total of 502 DLUs (mean, 5 per patient; 102 vascular, 91 bronchial, and 309 linear cutters) were used in this series. There were no major operative complications. The mean operating time was 136 ± 41 minutes. One bronchial dehiscence and one incomplete sealing of the pulmonary vein in the staple line were observed. In one patient, the linear cutter could not be opened in the automatic setting. There were 15% misreads by the computer on the DLU or their inserts. There was one hospital death unrelated to the stapling. Twenty additional complications included prolonged chest tube drainage (n = 8), reoperations (n = 2), atrial fibrillation (n = 5), hemothorax (n = 1), chylothorax (n = 1), C-dif colitis (n = 1), myocardial ischemia (n = 1), and incarcerated ventral hernia (n = 1). The median hospital length of stay was 5 days (range, 3 to 26 days) and the median length of chest tube drainage was 3 days (1 to 22 days). Conclusions Our experience shows that the computer-mediated power stapling of lung parenchyma and hilar structures during anatomic resection is safe and reproducible.

Is Tracheostomy Insertion an Indication for Gastrostomy Insertion?

2019 ◽  
Vol 85 (5) ◽  
pp. 518-523 ◽  
Author(s):  
Justin Dvorak ◽  
David Ridder ◽  
Brendan Martin ◽  
Hieu Ton-That ◽  
Anthony Baldea ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Acute Care Surgery ◽  
Patient Demographics ◽  
Endoscopic Gastrostomy ◽  
Concomitant Procedure ◽  
Included Patient ◽  
Care Surgery

The aim of the study was to determine the frequency of surgical patients who undergo tracheostomy and gastrostomy insertion during the same hospitalization. Secondary outcomes included ICU and hospital length of stay (LOS) for patients who underwent concomitant tracheostomy and gastrostomy versus those who did not. This study is a retrospective review of trauma and acute care surgery (ACS) patients between 2006 and 2015 who underwent tracheostomy. Patients who also underwent open gastrostomy or percutaneous endoscopic gastrostomy during the same hospitalization were identified. Data collected included patient demographics, hospital LOS, ICU LOS, and timing of tracheostomy and gastrostomy. Three hundred one trauma and ACS patients who underwent tracheostomy were identified. Seventy- three per cent of tracheostomy patients underwent gastrostomy during the same admission. Of patients who had both tubes inserted, 79 per cent (175) underwent gastrostomy with tracheostomy as the concomitant procedure, whereas 21 per cent received gastrostomy as a delayed procedure. Median hospital LOS for patients who underwent concomitant procedures was 25 days versus 22 days for those who had delayed or no gastrostomy ( P = 0.24). Eighty-four per cent of patients who had tracheostomy for prolonged or anticipated prolonged mechanical ventilation were receiving tube feeds at discharge, and 78 per cent had not been advanced to an oral diet at discharge. Most trauma/ACS patients who undergo tracheostomy also undergo gastrostomy during their hospitalization. Concomitant gastrostomy is not associated with a decrease in hospital LOS; however, most patients who undergo tracheostomy for prolonged mechanical ventilation are discharged receiving enteral nutrition. These patients may benefit from concomitant ICU gastrostomy as a way to improve efficiency and cost-saving.

Outcome of Patients After Air Medical Transport for Management of Nontraumatic Acute Intracranial Bleeding

1994 ◽  
Vol 9 (4) ◽  
pp. 252-256 ◽  
Author(s):  
Robert Silbergleit ◽  
Richard E. Burney ◽  
Janine Draper ◽  
Kris Nelson
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Length ◽  
Intracranial Bleeding ◽  
Hospital Length Of Stay ◽  
Coma Scale ◽  
Management Measures ◽  
Before And After ◽  
Acute Subarachnoid Hemorrhage ◽  
Gcs Score ◽  
Hospital Days

AbstractIntroduction:Patients with acute, intracranial bleeding (ICB), particularly from intracranial aneurysms, are believed to be at high risk for rebleeding or neurologic deterioration if subjected to noise, motion, or stress, but are transported by helicopter with increasing frequency. This study was undertaken to examine the characteristics, safety, and outcomes of air transport for patients with acute subarachnoid hemorrhage (SAH) or other forms of acute ICB in an air medical system.Methods:Charts of all patients with spontaneous, acute ICB who were transported by air from 1986 through 1989 were reviewed. Age, gender, time of transport, transport management measures, pre- and post-transport Glasgow Coma Scale (GCS) score, intensive care unit (ICU) and hospital days, operations, and mortality were compiled for all patients and analyzed.Results:Eighty-seven patients ranging in age from 2 to 83 years (mean: 47.5 ±18.5 years) met entry criteria. The source of bleeding was cerebral aneurysm in 37 patients; intraparenchymal hemorrhage in 29; an unidentified vascular source in 11; and arteriovenous malformation (AVM) in 10. Mean GCS score measured in 69 patients before and after transport was 10.5 ±4.5 Glasgow Coma Scale score did not change during transport in 61 patients (88%), improved in three (4%), and deteriorated in five (7%). Fifty-nine patients (69%) underwent operations, 36 (41%) within 24 hours of arrival. Mean ICU stay was 14 days (95% CI: 12–15); mean hospital stay was 36 days (95% CI: 27–45 days). Overall mortality was 25% (95% CI: 16–34 days). A GCS score of 3 to 8 at time of transport was associated with both increased hospital length of stay and higher mortality. Patients transported within eight hours of symptom onset had lower GCS scores, but out-come measures were not significantly different from those transported later.Conclusion:Emergency air medical transfer of patients with acute ICB for definitive neurosurgical care appears to be both safe and effective, and facilitates early definitive diagnosis and operative intervention.

scholarly journals Endoscopic thoracic discectomy

2000 ◽  
Vol 9 (4) ◽  
pp. 1-8 ◽  
Author(s):  
J. Patrick Johnson ◽  
Aaron G. Filler ◽  
Duncan Q. McBride
Keyword(s):  
Blood Loss ◽  
Chest Tube ◽  
Operative Time ◽  
Surgical Techniques ◽  
Invasive Procedure ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Steep Learning Curve ◽  
Thoracic Discectomy

Object Thoracoscopic discectomy is a minimally invasive procedure simulating a thoracotomy and is an alternative to the costotransversectomy and transpedicular approaches. In recent studies authors have concluded that thoracoscopic discectomy is the preferred procedure; however, relative historical comparisons were difficult to interpret. The authors conducted a prospective nonrandomized study in which they compared data on 36 patients undergoing thoracoscopic discectomy with eight patients undergoing thoracotomy between 1995 and 1999. Methods Patients affected with one- or two-level lesions underwent a thoracoscopic discectomy, and patients with three-level lesions or more underwent thoracotomy and discectomy. Data were collected on operative time, blood loss, chest tube duration, narcotic agent use, and hospital length of stay (LOS). Longer-term follow-up study of pain-related symptoms and neurological function was conducted. Patients who underwent thoracoscopic discectomy had shorter operative times, less blood loss, a shorter period of chest tube drainage dependence, less narcotic usage, and a shorter LOS. These findings were statistically significant (p < 0.05) for narcotic usage and shorter LOS. Pain related to radiculopathy was improved by means of 75%, and no patients exprienced worsened pain. In patients with myelopathy there was an improvement of two Frankel grades in the thoracoscopic group and one Frankel grade in the thoracotomy discectomy group, but patients in the thoracotomy group were significantly worse preoperatively. One myelopathic patient from each group suffered a worsened outcome postoperatively, although this was not attributed to the method of surgery. The incidence of complications (minor and major) was 31% in the thoracoscopic group and greater than 100% (that is, more than one complication per patient) in the thoracotomy/discectomy group. Conclusions One advantage to thoracoscopic discectomy is its reduced incidence of morbidity compared with thoractomy, but its steep learning curve and unfamiliar surgical techniques make this procedure less practical for surgeons not performing it frequently. The more familiar costotransversectomy, transpedicular, and thoracotomy procedures remain viable alternatives for surgeons more experienced in these procedures.

scholarly journals In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight

2018 ◽  
Vol 15 (8) ◽  
pp. 1570 ◽  
Author(s):  
Monica Eneriz-Wiemer ◽  
Lee Sanders ◽  
Mary McIntyre ◽  
Fernando Mendoza ◽  
D. Do ◽  
...  
Keyword(s):  
Birth Weight ◽  
Length Of Stay ◽  
Low Birth Weight ◽  
Healthcare Providers ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Interpreter Use ◽  
Adjusted Incidence Rate ◽  
Hospital Days ◽  
Adjusted Incidence

To ensure timely appropriate care for low-birth-weight (LBW) infants, healthcare providers must communicate effectively with parents, even when language barriers exist. We sought to evaluate whether non-English primary language (NEPL) and professional in-person interpreter use were associated with differential hospital length of stay for LBW infants, who may incur high healthcare costs. We analyzed data for 2047 infants born between 1 January 2008 and 30 April 2013 with weight <2500 g at one hospital with high NEPL prevalence. We evaluated relationships of NEPL and in-person interpreter use on length of stay, adjusting for medical severity. Overall, 396 (19%) had NEPL parents. Fifty-three percent of NEPL parents had documented interpreter use. Length of stay ranged from 1 to 195 days (median 11). Infants of NEPL parents with no interpreter use had a 49% shorter length of stay (adjusted incidence rate ratio (IRR) 0.51, 95% confidence interval (CI) 0.43–0.61) compared to English-speakers. Infants of parents with NEPL and low interpreter use (<25% of hospital days) had a 26% longer length of stay (adjusted IRR 1.26, 95% CI 1.06–1.51). NEPL and high interpreter use (>25% of hospital days) showed a trend for an even longer length of stay. Unmeasured clinical and social/cultural factors may contribute to differences in length of stay.

Intraoperative Implementation of a Tissue Sealant on All Lung Surgery Patients: A Quality Improvement Project

2015 ◽  
Vol 8 (1) ◽  
pp. 125-129
Author(s):  
Stephanie Cain ◽  
Richard Anderson ◽  
Patricia Stockert ◽  
Suzanne Brown ◽  
Jane Blood-Siegfried
Keyword(s):  
Length Of Stay ◽  
Chest Tube ◽  
Length Of Hospital Stay ◽  
Clinical Problem ◽  
Hospital Length Of Stay ◽  
Air Leak ◽  
Improvement Project ◽  
Air Leaks ◽  
Pulmonary Surgery ◽  
Tissue Sealant

More than 200,000 patients undergo pulmonary surgery annually. Air leaks after pulmonary surgery are a common complication and represent a substantial clinical problem. Air leaks can increase chest tube time, increase pain, reduce mobility, and increase hospital length of stay. The application of a synthetic surgical lung sealant (SLS) to lung surfaces during surgery in patients at risk for an air leak has been advocated to reduce these complications.The aim of the project was to reduce or eliminate air leaks, decrease chest tube time, and decrease length of stay by applying an FDA-approved tissue sealant during all pulmonary surgeries. The population of focus were adult pulmonary surgery patients undergoing pulmonary surgery.Data were collected on 146 patients: 72 patients the year prior to the intervention and 74 the year after implementation of the intervention. The incidence of air leak was significantly lower; the number of comorbidities was statistically higher in the group following implementation. There were, however, no significant differences in chest tube duration and length of hospital stay. The use of lung sealant on all patients undergoing pulmonary surgery had a positive outcome without any adverse effects and is now standard of practice.

scholarly journals Low suction on digital drainage devices promptly improves post-operative air leaks following lung resection operations: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Suguru Mitsui ◽  
Shunsuke Tauchi ◽  
Takahiro Uchida ◽  
Hisashi Ohnishi ◽  
Toshio Shimokawa ◽  
...  
Keyword(s):  
Chest Tube ◽  
Pulmonary Resection ◽  
Lung Resection ◽  
Low Pressure ◽  
Volume Of Fluid ◽  
Suction Pressure ◽  
Air Leaks ◽  
Tube Removal ◽  
Chest Tube Removal ◽  
Pressure Suction

Abstract Background We investigated the most effective suction pressure for preventing or promptly improving postoperative air leaks on digital drainage devices after lung resection. Methods We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection in our institution between December 2017 and June 2020. We divided the patients into three groups according to the suction pressure used: A (low-pressure suction group: − 5 cm H2O), B (intermediate-pressure group: − 10 cm H2O), and C (high-pressure suction group: − 20 cm H2O). We evaluated the duration of air leaks, timing of chest tube replacement, the amount of postoperative air leak, volume of fluid drained before chest tube removal, and the total number of air leaks during drainage. Results In total, 217 patients were included in this study. The duration of air leaks gradually decreased with significant difference between the groups, the highest decrease in A, the lowest decrease in C (P = 0.019). Timing of chest tube replacement, on the other hand, did not significantly differ between the three groups (P = 0.126). The number of postoperative air leaks just after surgery did not significantly differ between the three groups (P = 0.175), but the number of air leaks on postoperative day 1 were fewest in group A, then B, and greatest in group C (P = 0.033). The maximum amount of air leaks during drainage was lowest in A, then B, and highest in C (P = 0.036). Volume of fluid drained before chest tube removal did not significantly differ between the three groups (P = 0.986). Conclusion Low-pressure suction after pulmonary resection seems to avoid or promptly improve postoperative air leaks in digital drainage devices after lung resection. Trial registration This is a single-institution, retrospective analysis-based study of data from an electronic database. Study protocol was approved by the Akashi Medical Center Institutional Research Ethics Board (approval number: 2020–9).

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