Ambulatory chest drainage with advanced nurse practitioner-led follow-up facilitates early discharge after thoracic surgery,General Thoracic and Cardiovascular Surgery

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Ambulatory chest drainage with advanced nurse practitioner-led follow-up facilitates early discharge after thoracic surgery
General Thoracic and Cardiovascular Surgery ( IF 1.1 ) Pub Date : 2022-10-10 , DOI: 10.1007/s11748-022-01873-9
Oliver J Harrison ₁ , Maria Elena Vilar Alvarez _{2,

3} , Victoria Snow ₁ , Alessandro Tamburrini ₁ , Edwin Woo ₁ , Lukacs Veres ₁ , Martin H Chamberlain ₁ , Aiman Alzetani ₁ ,

Affiliation

Objectives

To demonstrate the safety and feasibility of advanced nurse practitioner-led (ANP-led) outpatient follow-up after discharge with ambulatory chest drains for prolonged air leak and excessive fluid drainage.

Methods

Patients discharged with ambulatory chest drains between January 2017 and December 2019 were retrospectively reviewed. Discharge criteria included air leak < 200 ml/min or fluid drainage > 100 ml/24 h on a digital drain. Patients were reviewed weekly in the clinic by ANPs, a highly skilled cohort of nurses with physician support available. Outcomes included length of stay, duration of air or fluid leak and complications.

Results

Two-hundred patients were included, amounting to 368 clinic episodes. The median age was 68 ± 13 years and 119 (60%) were male. 112 (56%) patients underwent anatomical lung resection (total anatomical lung resections during the study period = 917) equating to a discharge with ambulatory chest drain rate of 12.2% in this group. The median length of stay was 6 ± 3 days and 176 (88%) patients were discharged with air leak versus 24 (12%) with excessive fluid drainage. The median time to drain removal was 12 ± 11 days. Complications occurred in 16 patients (8%) and 12 (6%) required readmission. An estimated 2075 inpatient days were saved over the study period equating to an annual cost saving of £123,167 (US$149,032) per annum.

Conclusions

Patients with air leak or excessive fluid drainage can safely be discharged with ambulatory chest drains, allowing them to return to their familiar home environment safely and quickly. ANP-led clinics are a robust and cost-effective follow-up strategy and are associated with a low complication rate.

中文翻译：

由高级执业护士指导的门诊胸腔引流有利于胸外科手术后的早期出院

目标

证明高级执业护士主导 (ANP-led) 门诊随访的安全性和可行性，出院后使用动态胸腔引流管治疗长期漏气和过多液体引流。

方法

回顾性分析了 2017 年 1 月至 2019 年 12 月期间因门诊胸腔引流出院的患者。出院标准包括漏气 < 200 ml/min 或数字引流管上的液体引流 > 100 ml/24 h。ANPs 每周在诊所对患者进行检查，ANPs 是一支技术娴熟的护士队伍，可提供医生支持。结果包括住院时间、漏气或漏液持续时间以及并发症。

结果

包括 200 名患者，共计 368 次临床发作。中位年龄为 68 ± 13 岁，119 人 (60%) 为男性。112 名 (56%) 患者接受了解剖性肺切除术（研究期间的总解剖性肺切除术 = 917），这相当于该组出院时门诊胸腔引流率为 12.2%。中位住院时间为 6 ± 3 天，176 名 (88%) 患者因漏气出院，24 名 (12%) 患者因液体引流过多而出院。去除引流管的中位时间为 12 ± 11 天。16 名患者 (8%) 出现并发症，12 名 (6%) 患者需要再次入院。在研究期间估计节省了 2075 个住院日，相当于每年节省 123,167 英镑（149,032 美元）的费用。