Abstract
Purpose
The necessity of a postoperative chest tube for the treatment of pneumothorax after a radical nephrectomy is controversial.
Materials and methods
A five-year retrospective study was performed on 91 patients, having undergone a radical nephrectomy. We examined the existence and length of a pleural rent, presence of a postoperative thoracostomy tube, postoperative pneumothorax, postoperative pneumonia, postoperative atelectasis, pain scores, hemoglobin saturation, and length of hospital stay with univariate and multivariate analysis.
Results
Incidence of a pleural rent occurred in 29 (36%) of open radical nephrectomy cases; 4 of the 29 cases had a postoperative thoracostomy tube. There was no significant difference in hemoglobin saturation levels between cases that had no pleural rent, a pleural rent without a thoracostomy tube, and a pleural rent with a postoperative thoracostomy tube. A pleural rent without a postoperative chest tube had significantly lower rates of pain score, atelectasis, pneumonia, pleural effusion, and length of hospital stay compared to individuals with a postoperative chest tube. Patients with a chest tube had a significantly higher incidence of pain, atelectasis, pneumonia, effusion, and length of hospital stay.
Conclusion
Iatrogenic pleural rents treated without a postoperative chest tube show a significant decrease in postoperative complications of pneumonia and atelectasis, pain score and length of hospital stay. These patients show no significant increases in postoperative complications; therefore, it appears that postoperative chest tube placement after a pleural injury occurs is of no advantage.
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Rutledge, M., Aronoff, D., de Riese, W. et al. Management of pleural injuries during retroperitoneal surgical procedures. Int Urol Nephrol 39, 717–722 (2007). https://doi.org/10.1007/s11255-006-9117-2
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DOI: https://doi.org/10.1007/s11255-006-9117-2