PMID- 19682917
OWN - NLM
STAT- MEDLINE
DCOM- 20100226
LR  - 20220321
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 36
IP  - 4
DP  - 2009 Oct
TI  - Routine placement of an intercostal chest drain during video-assisted 
      thoracoscopic surgical lung biopsy unnecessarily prolongs in-hospital length of 
      stay in selected patients.
PG  - 737-40
LID - 10.1016/j.ejcts.2009.04.067 [doi]
AB  - OBJECTIVE: Video-assisted thoracoscopic surgical (VATS) lung biopsy is frequently 
      used in the diagnosis of parenchymal lung disease. However, there is still debate 
      over the need for routine use of an intercostal chest drain after this procedure. 
      This study aimed to evaluate the necessity of positioning an intercostal chest 
      drain as an integral part of VATS lung biopsy. METHODS: Data from VATS lung 
      biopsies performed over a 5-year period were retrospectively analysed. Patients 
      in whom there was evidence of air leak intra-operatively following lung biopsy 
      were excluded. Patients in whom no air leak was detected on testing were included 
      in this study. A chest drain was inserted solely according to the surgeons' 
      practice. RESULTS: This study included 175 patients. Of these, 82 patients had an 
      intercostal chest drain positioned during the VATS procedure and 93 did not. 
      There were no significant differences between the two groups in terms of mean 
      (standard deviation (SD)), age (54.4 (14.9) vs 55.8 (13.5) years, p=0.58), gender 
      (63% vs 59% males, p=0.56) or side of procedure (45% vs 56% right side, p=0.22). 
      One patient in the 'no drain' group developed a clinically significant 
      pneumothorax 24h after surgery and required a drain to be inserted. There was 
      also no significant difference between the two groups in the incidence of 
      radiologically detected pneumothorax immediately post-procedure (23% vs 20%, 
      p=0.66) or on postoperative day 1 (26% vs 20%, p=0.63). There was no significant 
      difference in the incidence of pneumothorax on follow-up (at 4-6 weeks) chest 
      radiograph (10% vs 7%, p=0.61). In all cases, the pneumothoraces were small and 
      not clinically significant. However, there was a significant difference in the 
      median (inter-quartile range (IQR)) length of stay between the two groups (3 
      (2,4) vs 2 (1,3) days, respectively, p<0.001). CONCLUSIONS: The routine use of an 
      intercostal chest drain after VATS lung biopsy unnecessarily increases the length 
      of hospital stay without reduction in the incidence of pneumothorax.
FAU - Satherley, Lucy K
AU  - Satherley LK
AD  - Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, 
      Wales, UK. lucysatherley@hotmail.com
FAU - Luckraz, Heyman
AU  - Luckraz H
FAU - Rammohan, Kandadai S
AU  - Rammohan KS
FAU - Phillips, Mabel
AU  - Phillips M
FAU - Kulatilake, Nihal E P
AU  - Kulatilake NE
FAU - O'Keefe, Peter A
AU  - O'Keefe PA
LA  - eng
PT  - Journal Article
DEP - 20090813
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adult
MH  - Aged
MH  - Biopsy/methods
MH  - *Chest Tubes
MH  - Female
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Lung/pathology
MH  - Lung Diseases/*pathology
MH  - Male
MH  - Middle Aged
MH  - Postoperative Care/methods
MH  - Retrospective Studies
MH  - Thoracic Surgery, Video-Assisted/*methods
MH  - Unnecessary Procedures
EDAT- 2009/08/18 09:00
MHDA- 2010/02/27 06:00
CRDT- 2009/08/18 09:00
PHST- 2008/11/02 00:00 [received]
PHST- 2009/04/20 00:00 [revised]
PHST- 2009/04/22 00:00 [accepted]
PHST- 2009/08/18 09:00 [entrez]
PHST- 2009/08/18 09:00 [pubmed]
PHST- 2010/02/27 06:00 [medline]
AID - S1010-7940(09)00489-8 [pii]
AID - 10.1016/j.ejcts.2009.04.067 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2009 Oct;36(4):737-40. doi: 10.1016/j.ejcts.2009.04.067. 
      Epub 2009 Aug 13.