Autologous blood pleurodesis for postoperative air leakage following video-assisted thoracoscopic surgery–a randomized controlled trial
Finn Amundsen Dittberner, Thomas Decker Christensen, Peter Bjørn LichtAbstract
Objectives
Postoperative air leakage following lung surgery prolongs chest drainage duration and length of hospitalization and the evidence regarding treatment with autologous blood pleurodesis (ABP) is scarce. We decided to investigate if ABP would influence postoperative air leakage when used on the first postoperative day following elective video-assisted thoracoscopic surgery (VATS).
Methods
In this multicenter randomized controlled trial, patients with an air leakage greater than 40 ml/min during cough and mobilization on their first postoperative day following elective VATS were randomized 1:1 to standard chest drain management with or without ABP (stratified by lobectomy or wedge resection). The chest drain was removed after standardized digital drainage criteria, and the primary endpoint was time to chest drain removal. Patients with persistent air leakage beyond postoperative day 7 were censored to allow for individualized management.
Results
A total of 268 patients were randomized (134 in each group), after lobectomy (n = 238) or wedge (n = 30). Median chest drain duration was 3.4 days (95% CI 3.0–4.9) in the ABP group versus 5.0 days (95% CI 4.0–6.8) in the control group (p = 0.007). By postoperative day 7, chest drains had been removed in 74% versus 62% of patients, respectively. ABP significantly increased the rate of chest drain removal (HR 1.49, 95% CI 1.11–2.01; p = 0.007). The treatment effect was consistent across both participating centers.
Conclusion
Early autologous blood pleurodesis significantly shortens chest drain duration in patients with postoperative air leakage following VATS. This simple and low-cost intervention should be considered in Enhanced Recovery After Surgery protocols after thoracic surgery.