John T Braun, Sofia C Federico, Cornelia Griggs, David M Lawlor, Daniel P Croitoru, Brian E Grottkau
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引用次数: 0
Abstract
Introduction: Though chest tube removal at the completion of an endoscopic thoracic procedure is well accepted in the pediatric and adult general surgery literature, this practice has never been studied in pediatric patients treated with anterior vertebral tethering (AVT) for AIS. This study retrospectively analyzed pulmonary complications in a large series of AIS patients consecutively treated with chest tube removal at the completion of AVT. The rate of pulmonary complication in this series was then compared with the published rate of pulmonary complication in patients managed with chest tube retention after AVT.
Methods: A retrospective review of all AIS patients treated with AVT over a twelve year period yielded 257 consecutive patients (248 primary/9 revision) with 349 curves. Out of a total of 349 chest tubes placed intraoperatively, as a routine step of the procedure, 323 were removed at procedure completion while 26 were maintained for 2-5 days post-operatively as warranted. Patient charts, radiographs, and CT scans were reviewed to confirm any pulmonary complications.
Results: In 257 AIS patients treated with AVT, 233 had chest tube removal at the completion of AVT with 4 (1.7%) peri-operative and 8 (3.4%) delayed pulmonary complications. Peri-operative complications included one symptomatic pneumothorax noted in the operating room that required chest tube reinsertion; one static pneumothorax that resolved without intervention; and two significant pleural effusions that resolved over time without intervention. Delayed complications included seven pleural effusions that occurred 2-6 weeks post-operatively and one chylothorax that occurred 1 week post-operatively. Several clinically significant pleural effusions (4/7) required thoracentesis or chest tube drainage but subsequently resolved. The chylothorax required chest tube drainage, dietary fat restriction, and treatment with octreotide. In 24 patients, 26 chest tubes were retained for 2-5 days post-op for a persistent air leak with presumed parenchymal injury (14), revision with significant adhesions (6), bleeding disorder (2), or diaphragmatic repair related to renal eventration (1) or congenital diaphragmic hernia (1).
Conclusion: This study demonstrated the relative safety of immediate chest tube removal at the completion of AVT in AIS patients. The rate of pulmonary complication in 233 patients with chest tube removal at the completion of AVT was 5.1% which compared favorably with a published rate of 10-11% after chest tube retention. In 24 patients with an indication for chest tube retention at the completion of AVT, chest tube retention for 2-5 days resulted in no pulmonary complications.
期刊介绍:
Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.