Tracking the outcomes of surgical treatment of Stage 2 and 3 empyema: introduction and consolidation of minimally invasive approach.

Autor: Patella M; Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland., Minerva EM; Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland., Porcellini I; Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland., Cianfarani A; Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland., Tessitore A; Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland., Cafarotti S; Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland.
Jazyk: angličtina
Zdroj: ANZ journal of surgery [ANZ J Surg] 2021 Oct; Vol. 91 (10), pp. 2182-2187. Date of Electronic Publication: 2021 Aug 17.
DOI: 10.1111/ans.17133
Abstrakt: Background: We described the results of surgical treatment of empyema, tracing outcomes throughout the passage from the open thoracotomy (OT) approach to video-assisted thoracoscopic surgery (VATS) in a single institute.
Methods: We retrospectively analyzed the records of 88 consecutive patients treated for Stage 2 and 3 empyema (2010-2019). We divided the study period into three groups: OT period (2010-2013), early VATS (2014-2017, from the introduction of VATS program, until acme of learning curve), and late VATS (2018-2019). Groups were compared to investigate the outcomes evolution.
Results: Most relevant findings of the study were significant variation in postoperative length of stay (median [interquartile range]: 9 days [7.5-10], 10 [7.5-17.5], and 7 [5-10] for OT period, early VATS, and late VATS, respectively, p = 0.005), hospital admission referral to thoracic surgery interval (7.5 days [4.5-11], 6.5 [3-9], and 2.5 [1.5-5.5], p = 0.003), chest tube duration (5.5 days [5-7.5], 6 [4-6], 4 [3-5], p = 0.003), and proportion of operation performed by residents (3 [15%], 6 [16.7%], 14 [43.6%], p = 0.01).
Conclusions: Our findings pictured the trajectory evolution of outcomes during introduction and consolidation of VATS treatment of empyema. During the early phase, we observed a decline in some indicators that improved significantly in the late VATS period. After a learning curve, all outcomes showed better results and we entered into a teaching phase.
(© 2021 Royal Australasian College of Surgeons.)
Databáze: MEDLINE
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