Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients
Journal
Surgical Endoscopy
Journal Volume
31
Journal Issue
4
Pages
1719-1727
Date Issued
2017
Author(s)
Abstract
Background: Parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction are risky to receive surgical decortication under general anesthesia. Non-intubated video-assisted thoracoscopy surgery is successfully performed to avoid complications of general anesthesia. We performed single-port non-intubated video-assisted flexible thoracoscopy surgery in an endoscopic center. In this study, the possible role of our modified surgery to treat fibrinopurulent stage of parapneumonic empyema with high operative risks is investigated. Methods: We retrospectively reviewed fibrinopurulent stage of parapneumonic empyema patients between July 2011 and June 2014. Thirty-three patients with coronary artery disease and reduced left ventricular ejection fraction were included in this study. One group received tube thoracostomy, and the other group received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. Patient demographics, characteristics, laboratory findings, etiology, and treatment outcomes were compared. Results: Mean age of 33 patients (24 males, 9 females) was 76.2?±?9.7?years. Twelve patients received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication, and 21 patients received tube thoracostomy. Visual analog scale scores on postoperative first hour and first day were not significantly different in two groups (p value?=?0.5505 and 0.2750, respectively). Chest tube drainage days, postoperative fever subsided days, postoperative hospital days, and total length of stay were significantly short in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication (p value?=?0.0027, 0.0001, 0.0009, and 0.0065, respectively). Morbidities were low, and mortality was significantly low (p value?=?0.0319) in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. Conclusions: Single-port non-intubated video-assisted flexible thoracoscopy surgery decortication may be suggested to be a method other than tube thoracostomy to deal with fibrinopurulent stage of parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction. ? 2016, Springer Science+Business Media New York.
SDGs
Other Subjects
aged; alpha hemolytic Streptococcus; Article; Charlson Comorbidity Index; chest tube; clamp; clinical article; clinical feature; Clostridium infection; Clostridium perfringens; coronary artery disease; demography; empyema; female; fever; fibrinopurulence; flexible bronchoscope; heart arrhythmia; heart left ventricle ejection fraction; hematothorax; high risk patient; human; hydrothorax; Klebsiella pneumoniae; Klebsiella pneumoniae infection; laboratory diagnosis; length of stay; lobar pneumonia; male; methicillin resistant Staphylococcus aureus; methicillin resistant Staphylococcus aureus infection; methicillin susceptible Staphylococcus aureus; morbidity; observational study; operation duration; operative blood loss; parapneumonic empyema; postoperative complication; priority journal; Pseudomonas aeruginosa; Pseudomonas infection; quality of life; respiratory failure; respiratory tract intubation; retrospective study; septic shock; Streptococcus constellatus; Streptococcus infection; suppuration; surgical infection; surgical mortality; surgical risk; thoracostomy; tracheostomy; treatment outcome; urosepsis; video assisted thoracoscopic decortication; video assisted thoracoscopic surgery; visual analog scale; complication; Empyema, Pleural; middle aged; procedures; risk; very elderly; video assisted thoracoscopic surgery; Aged; Aged, 80 and over; Coronary Artery Disease; Empyema, Pleural; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk; Thoracic Surgery, Video-Assisted; Treatment Outcome
Publisher
Springer New York LLC
Type
journal article