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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2003 Dicembre;44(6):771-3

lingua: Inglese

Effect of fibrin glue on air leak and length of hospital stay after pulmonary lobectomy

Gagarine A., Urschel J. D., Miller J. D., Bennett W. F., Young J. E. M.

Depart­ment of Sur­gery, McMaster Uni­ver­sity, Ham­ilton, ­Ontario, ­Canada


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Aim. Air ­leaks are a ­common ­cause of mor­bidity and pro­longed hos­pital ­stay ­after pul­mo­nary lobec­tomy. We ­reviewed our expe­ri­ence ­with intra­op­er­a­tive ­fibrin ­glue to deter­mine if it ­reduced air ­leak and ­improved ­patient out­comes.
­Methods. ­Records of ­patients under­going pul­mo­nary lobec­tomy for ­benign or malig­nant dis­ease ­over a 4-­year ­period (1998-2001) ­were ­reviewed. ­Data was col­lected on age, sex, pul­mo­nary func­tion, pul­mo­nary ­pathology, use of ­fibrin ­glue, dura­tion of ­chest ­tube ­drainage, ­length of hos­pital ­stay, and post­op­er­a­tive com­pli­ca­tions.
­Results. ­Three hun­dred and ­sixty ­patients under­went lobec­tomy. ­Fibrin ­glue was ­used intra­op­er­a­tively to ­seal air ­leaks in 102 of the 360 ­patients (­study ­group: 102; con­trol ­group: 258). ­Fibrin ­glue was ­used at the dis­cre­tion of the sur­geon, ­with ­some sur­geons ­using it rou­tinely. The ­groups did not ­differ in age (p=0.29), sex (p=0.42), FEV1 (p=0.57), or ­pathology (p=0.08). ­There ­were no dif­fer­ences in out­comes ­such as oper­a­tive mor­tality (­study: 2 of 102, con­trol: 6 of 258, p=0.85), ­empyema (­study: 0 of 102, con­trol: 3 of 258, p=0.55), pro­longed (>7 ­days) air ­leaks (­study: 10 of 20; con­trol: 20 of 258, p=0.71), or ­length of hos­pital ­stay (­study: 6.3±2.5 ­days, con­trol: 7.7±7.2 ­days, p=0.83). The use of ­fibrin ­glue was asso­ciated ­with a reduc­tion in the dura­tion of ­chest ­tube intu­ba­tion (­study: 4.1±3.2 ­days, con­trol: 5.5±3.8 ­days, p=0.001).
Con­clu­sion. ­Patients ­treated intra­op­er­a­tively ­with ­fibrin ­glue had a sig­nif­i­cantly ­shorter dura­tion of ­chest ­tube intu­ba­tion ­after pul­mo­nary lobec­tomy ­than ­those ­treated con­ven­tion­ally. How­ever, the use of ­fibrin ­glue did not sig­nif­i­cantly influ­ence ­more clin­i­cally rel­e­vant out­comes ­such as ­length of hos­pital ­stay and inci­dence of pro­longed (>7 ­days) air ­leaks.

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