| Open window thoracostomy: modern update of an ancient operation. | |
| | |
MedLine Citation:
|
PMID: 20514577 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
INTRODUCTION: In modern day thoracic surgical practice, better understanding of the pathophysiology of intrathoracic infections, improved antibiotic therapy and advancements in thoracic surgical techniques have decreased the use of procedures such as open window thoracostomy (OWT). Despite this, there are occasions where OWT cannot be avoided, and it is of interest where its current utility lies. To determine the current efficacy of OWT, we reviewed our recent experience with a focus on the indications, timing of surgery, effectiveness in clearing infection, patient survival, and timing of closure. METHODS: After Institutional Review Board approval, charts of 78 patients were reviewed. Dates reviewed were from 1/1/1998 to 1/1/2008. Patients were predominantly male (66 %) with a median age 58 years. Median time from initial diagnosis to OWT was 70 days (range 1 to 720 days). RESULTS: Primary indication for surgery was empyema in 75 (96 %), and most patients had previous thoracic surgery. The most frequent causes of empyema were post-pneumonectomy (n = 25), post-pneumonic (n = 14), and post-lobectomy (n = 9). Bronchopleural fistulae were present in 29 (37 %) cases. Lung cancer was diagnosed in 34 (45 %) patients, and 24 underwent perioperative radiation therapy. Patient survival at 1 month, 6 months, 1 year and 5 years was 94 %, 82 %, 74 % and 60 %, respectively, with an in-hospital mortality of 6.4 %. Infection was controlled in nearly all patients (n = 72). Fifteen (19 %) patients underwent surgical closure for OWT; in 2 (2.6 %), OWT closed spontaneously. CONCLUSIONS: Currently, open window thoracostomy is used to treat complex empyema incurred from pulmonary resection, cancer and/or infection in patients that cannot be managed by more conservative strategies. Overall mortality and morbidity rates are acceptable in this debilitated patient group. |
| | |
Authors:
|
K G Reyes; D P Mason; S C Murthy; J W Su; T W Rice |
Related Documents
:
|
18419207 - Thoracic complications of urologic laparoscopy: correlation between radiographic findin... 19903687 - Ultrasound estimation of volume of postoperative pleural effusion in cardiac surgery pa... 19886267 - Thoracoscopic creation of a pericardial window in dogs. 3272807 - The incidence and significance of early pericardial effusion after open heart surgery. 7792707 - Giant cephalhematoma in a 15-year-old boy. unilateral amaurosis as the main complication. 21616267 - Resection of a duodenal web using single-incision pediatric endosurgery. |
Publication Detail:
|
Type: Journal Article Date: 2010-05-31 |
Journal Detail:
|
Title: The Thoracic and cardiovascular surgeon Volume: 58 ISSN: 1439-1902 ISO Abbreviation: Thorac Cardiovasc Surg Publication Date: 2010 Jun |
Date Detail:
|
Created Date: 2010-06-01 Completed Date: 2010-09-07 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 7903387 Medline TA: Thorac Cardiovasc Surg Country: Germany |
Other Details:
|
Languages: eng Pagination: 220-4 Citation Subset: IM |
Affiliation:
|
Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Bronchial Fistula
/
etiology,
surgery Empyema, Pleural / etiology, microbiology, mortality, surgery* Female Hospital Mortality Humans Kaplan-Meiers Estimate Lung Neoplasms / complications Male Middle Aged Ohio Pulmonary Surgical Procedures / adverse effects Reoperation Thoracostomy / adverse effects, methods*, mortality Time Factors Treatment Outcome Wound Healing |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Integrated Positron Emission Tomography-Computed Tomography Does Not Accurately Stage Intrathoracic ...
Next Document: Effect of Intrapleural Povidone-Iodine Lavage on Thyroid Hormones in Thoracic Surgery.