New research was presented at STS 2015, the annual meeting of the Society of Thoracic Surgeons, from January 24 to 28 in San Diego. The features below highlight some of the studies that emerged from the conference.
Home Discharge for Some Pulmonary Resections
The Particulars: Some patients who develop air leaks after pulmonary resection cannot be discharged home after their procedure because they are at risk of developing emphysema or an enlarged pneumo-thorax. A digital outpatient device may allow for safe discharge to home for some of these patients.
Data Breakdown: For a study, patients who underwent pulmonary resection were discharged home on a digital air leak system with self-contained suction (DSS). The most common indications for the DSS were air leak monitoring (70%) and subcutaneous emphysema (24%), and the average air leak size was 400 cc/breath. Only 9% of patients developed complications at home that required readmission.
Take Home Pearl: A DSS device appears to be safe and effective for home therapy of persistent or large air leaks following pulmonary resection.
Predicting Post-Lobectomy Length of Stay
The Particulars: Determining the factors that contribute to longer length of stay (LOS) after lobectomy may provide strategies for reducing LOS in the future.
Data Breakdown: In a study of more than 6,700 lobectomy cases, researchers found that frailty, emergency surgery, operative time, and receipt of thoracotomy were preoperative predictors of LOS outliner status. This status for LOS was defined as occurring in more than the 75th percentile of cases, which was clarified as 9 days.
Take Home Pearl: Several preoperative factors appear to predict longer LOS for patients undergoing lobectomy and should be viewed as targets to potentially reduce LOS.
Determining Operative Mortality for rAAAD
The Particulars: Acute type A aortic dissection (AAAD) is a surgical emergency with high mortality rates. Understanding who is at increased risk of death could enable surgeons to take steps to address these factors.
Data Breakdown: Patients who presented with a ruptured AAAD (rAAAD) between 1999 and 2013 were compared with those without it for a study. Patients older than 70 and those presenting with aortic branch malperfusion were at greatest risk for early mortality. For patients without rAAAD, the survival rates were 77% at 5 years and 58% at 10 years, compared with rates of 55% and 43%, respectively, observed in patients with rAAAD. Older age and presenting with branch vessel malperfusion appeared to increase risks for early mortality.
Take Home Pearls: Surgical repair of AAAD appears to have acceptable results, even in the setting of aortic rupture. Long-term survival rates appear to be high for non- ruptured AAAD and acceptable for rAAAD.
