AI Article Synopsis
- Surgical incision type matters in lung transplants; Thoracotomy yields higher pain scores compared to Sternotomy, but less postoperative hemorrhage and shorter ICU stays.
- A retrospective study of 341 lung transplant patients examined differences in outcomes based on surgical access (Thoracotomy, Sternotomy, and Clamshell) and analgesic methods (epidural vs. intravenous opioids).
- Thoracotomy showed a median blood loss of 500 mL, with shorter mechanical ventilation times (19 hours) and quicker ICU discharges, despite requiring more pain management support through epidurals.
Article Abstract
There is paucity of data on the impact of surgical incision and analgesia on relevant outcomes.A retrospective STROBE-compliant cohort study was performed between July 2007 and August 2017 of patients undergoing lung transplantation. Gender, age, indication for lung transplantation, and the 3 types of surgical access (Thoracotomy (T), Sternotomy (S), and Clamshell (C)) were used, as well as 2 analgesic techniques: epidural and intravenous opioids. Outcome variables were: pain scores; postoperative hemorrhage in the first 24 hours, duration of mechanical ventilation, and length of stay at intensive care unit (ICU).Three hundred forty-one patients were identified. Thoracotomy was associated with higher pain scores than Sternotomy (OR 1.66, 95% CI: 1.01; 2.74, P: .045) and no differences were found between Clamshell and Sternotomy incision. The median blood loss was 800 mL [interquartile range (IQR): 500; 1238], thoracotomy patients had 500 mL [325; 818] (P < .001). Median durations of mechanical ventilation in Thoracotomy, Sternotomy, and Clamshell groups were 19 [11; 37] hours, 34 [IQR 16; 57.5] hours, and 27 [IQR 15; 50.5] hours respectively. Thoracotomy group were discharged earlier from ICU (P < .001).Thoracotomy access produces less postoperative hemorrhage, duration of mechanical ventilation, and lower length of stay in ICU, but higher pain scores and need for epidural analgesia.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7668481 | PMC |
| http://dx.doi.org/10.1097/MD.0000000000022427 | DOI Listing |
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