Impact factors for early extubation and drainage volume after sublobectomy: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Caiyi ^1,2 , LIU Xingchi ² , XU Shiguang ² , XU Wei ² , CHENG Ming ² , HU Boxiao ² ,  LIU Bo ²

1. Liaoning Cancer Hospital & Institute, Shenyang, 110016, P. R. China;
2. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;

Corresponding author：

LIU Bo, Email: 15309883996@qq.com

Keywords：

Sublobectomy; early extubation; postoperative pleural drainage volume; enhanced recovery after surgery; propensity score matching

DOI：

10.7507/1007-4848.202302081

Video：

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Objective To compare the incidence of complications after removal of chest drainage tube in the early and late stages after sublobectomy for non-small cell lung cancer (NSCLC), and to analyze the factors affecting postoperative pleural drainage volume (PDV), so as to explore the countermeasures and achieve rapid postoperative rehabilitation. Methods The patients with NSCLC who underwent minimally invasive sublobectomy in our hospital from January to October 2021 were enrolled. According to the median time of extubation, the patients were divided into an early extubation group (time with tube≤3 days) and a late extubation group (time with tube>3 days). The patients were matched via propensity score matching with a ratio of 1:1 and a caliper value of 0.02. The incidence of complications and perioperative parameters after removal of the thoracic drainage tube were analyzed and compared between the two groups, and univariate and multiple linear regression analyses were performed. Results A total of 157 patients were enrolled, including 79 males and 78 females, with an average age of (58.22±11.06) years. There were 76 patients in the early extubation group, 81 patients in the late extubation group, and 56 patients were in each group after propensity score matching. Compared with late extubation group, there was no significant difference in the incidence of infection after extubation (10.7% vs. 16.1%, P=0.405) or pleural effusion after extubation (5.4% vs. 3.6%, P=0.647) in early extubation group, and there was no second operation in both groups. Univariate analysis showed that smoking history (P=0.001), postoperative serum albumin reduction value (P=0.017), surgical approach (P=0.014), lesion location (P=0.027), differentiation degree (P=0.041), TNM stage (P=0.043), number of dissected lymph nodes (P=0.016), and intraoperative blood loss (P=0.016) were infuencing factors for increased postoperative PDV. Multiple linear regression analysis showed that smoking history (P=0.002), postoperative serum albumin reduction value (P=0.041), and the number of dissected lymph nodes (P=0.023) were independent risk factors for increased postoperative PDV. Conclusion There is no significant difference in the incidence of complications after extubation between early and late extubations. Preoperative smoking history, excessive postoperative serum albumin decreases, and excessive number of dissected lymph nodes during the surgery are independent risk factors for increased postoperative PDV.

Citation： ZHANG Caiyi, LIU Xingchi, XU Shiguang, XU Wei, CHENG Ming, HU Boxiao, LIU Bo. Impact factors for early extubation and drainage volume after sublobectomy: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(1): 87-93. doi: 10.7507/1007-4848.202302081 Copy

1.	Thai AA, Solomon BJ, Sequist LV, et al. Lung cancer. Lancet, 2021, 398(10299): 535-554.
2.	Wood DE, Kazerooni EA, Baum SL, et al. Lung cancer screening, version 3. 2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2018, 16(4): 412-441.
3.	Toumazis I, Bastani M, Han SS, et al. Risk-based lung cancer screening: A systematic review. Lung Cancer, 2020, 147: 154-186.
4.	Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology, 2020, 25 Suppl 2: 49-60.
5.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
6.	Fiore JF, Bejjani J, Conrad K, et al. Systematic review of the influence of enhanced recovery pathways in elective lung resection. J Thorac Cardiovasc Surg, 2016, 151(3): 708-715.
7.	Bjerregaard LS, Jensen K, Petersen RH, et al. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 mL/day. Eur J Cardiothorac Surg, 2014, 45(2): 241-246.
8.	Xing T, Li X, Liu J, et al. Early removal of chest tubes leads to better short-term outcome after video-assisted thoracoscopic surgery lung resection. Ann Transl Med, 2020, 8(4): 101.
9.	Deng B, Qian K, Zhou JH, et al. Optimization of chest tube management to expedite rehabilitation of lung cancer patients after video-assisted thoracic surgery: A meta-analysis and systematic review. World J Surg, 2017, 41(8): 2039-2045.
10.	Motono N, Iwai S, Funasaki A, et al. What is the allowed volume threshold for chest tube removal after lobectomy: A randomized controlled trial. Ann Med Surg (Lond), 2019, 43: 29-32.
11.	Azzi JL, Gottlieb B, Maziak DE, et al. Early identification of patients who will meet 24-hour fluid output threshold for chest tube removal after lung resection. Semin Thorac Cardiovasc Surg, 2019, 31(4): 861-867.
12.	Schmid S, Kaafarani M, Baldini G, et al. Implication of a novel postoperative recovery protocol to increase day 1 discharge rate after anatomic lung resection. J Thorac Dis, 2021, 13(11): 6399-6408.
13.	Zhang Y, Li H, Hu B, et al. A prospective randomized single-blind control study of volume threshold for chest tube removal following lobectomy. World J Surg, 2014, 38(1): 60-67.
14.	Salito C, Bovio D, Orsetti G, et al. Effect of lung resection on pleuro-pulmonary mechanics and fluid balance. Respir Physiol Neurobiol, 2016, 221: 35-40.
15.	Eid AA, Keddissi JI, Kinasewitz GT. Hypoalbuminemia as a cause of pleural effusions. Chest, 1999, 115(4): 1066-1069.
16.	Jermihov A, Tsalatsanis A, Kulkarni S, et al. Effect of lowest postoperative pre-albumin on outcomes after robotic-assisted pulmonary lobectomy. JSLS, 2021, 25(3): e2021.00043.
17.	Demoor T, Bracke KR, Vermaelen KY, et al. CCR7 modulates pulmonary and lymph node inflammatory responses in cigarette smoke-exposed mice. J Immunol, 2009, 183(12): 8186-8194.
18.	Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
19.	Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev, 2014, 2014(3): CD002294.
20.	Krochmal R, Arias S, Yarmus L, et al. Diagnosis and management of pulmonary nodules. Expert Rev Respir Med, 2014, 8(6): 677-691.
21.	Shao W, Zhang Z, Liu Z, et al. The value of pulmonary nodule diameter and consolidation/tumor rate in the prediction of lymph node metastasis in early-stage (cT1N0M0) lung adenocarcinoma. Transl Cancer Res, 2021, 10(1): 38-46.
22.	Ding N, Mao Y, Gao S, et al. Predictors of lymph node metastasis and possible selective lymph node dissection in clinical stageⅠA non-small cell lung cancer. J Thorac Dis, 2018, 10(7): 4061-4068.
23.	Yan S, Wang X, Lv C, et al. Mediastinal micro-vessels clipping during lymph node dissection may contribute to reduce postoperative pleural drainage. J Thorac Dis, 2016, 8(3): 415-421.

1. Thai AA, Solomon BJ, Sequist LV, et al. Lung cancer. Lancet, 2021, 398(10299): 535-554.
2. Wood DE, Kazerooni EA, Baum SL, et al. Lung cancer screening, version 3. 2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2018, 16(4): 412-441.
3. Toumazis I, Bastani M, Han SS, et al. Risk-based lung cancer screening: A systematic review. Lung Cancer, 2020, 147: 154-186.
4. Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology, 2020, 25 Suppl 2: 49-60.
5. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
6. Fiore JF, Bejjani J, Conrad K, et al. Systematic review of the influence of enhanced recovery pathways in elective lung resection. J Thorac Cardiovasc Surg, 2016, 151(3): 708-715.
7. Bjerregaard LS, Jensen K, Petersen RH, et al. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 mL/day. Eur J Cardiothorac Surg, 2014, 45(2): 241-246.
8. Xing T, Li X, Liu J, et al. Early removal of chest tubes leads to better short-term outcome after video-assisted thoracoscopic surgery lung resection. Ann Transl Med, 2020, 8(4): 101.
9. Deng B, Qian K, Zhou JH, et al. Optimization of chest tube management to expedite rehabilitation of lung cancer patients after video-assisted thoracic surgery: A meta-analysis and systematic review. World J Surg, 2017, 41(8): 2039-2045.
10. Motono N, Iwai S, Funasaki A, et al. What is the allowed volume threshold for chest tube removal after lobectomy: A randomized controlled trial. Ann Med Surg (Lond), 2019, 43: 29-32.
11. Azzi JL, Gottlieb B, Maziak DE, et al. Early identification of patients who will meet 24-hour fluid output threshold for chest tube removal after lung resection. Semin Thorac Cardiovasc Surg, 2019, 31(4): 861-867.
12. Schmid S, Kaafarani M, Baldini G, et al. Implication of a novel postoperative recovery protocol to increase day 1 discharge rate after anatomic lung resection. J Thorac Dis, 2021, 13(11): 6399-6408.
13. Zhang Y, Li H, Hu B, et al. A prospective randomized single-blind control study of volume threshold for chest tube removal following lobectomy. World J Surg, 2014, 38(1): 60-67.
14. Salito C, Bovio D, Orsetti G, et al. Effect of lung resection on pleuro-pulmonary mechanics and fluid balance. Respir Physiol Neurobiol, 2016, 221: 35-40.
15. Eid AA, Keddissi JI, Kinasewitz GT. Hypoalbuminemia as a cause of pleural effusions. Chest, 1999, 115(4): 1066-1069.
16. Jermihov A, Tsalatsanis A, Kulkarni S, et al. Effect of lowest postoperative pre-albumin on outcomes after robotic-assisted pulmonary lobectomy. JSLS, 2021, 25(3): e2021.00043.
17. Demoor T, Bracke KR, Vermaelen KY, et al. CCR7 modulates pulmonary and lymph node inflammatory responses in cigarette smoke-exposed mice. J Immunol, 2009, 183(12): 8186-8194.
18. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
19. Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev, 2014, 2014(3): CD002294.
20. Krochmal R, Arias S, Yarmus L, et al. Diagnosis and management of pulmonary nodules. Expert Rev Respir Med, 2014, 8(6): 677-691.
21. Shao W, Zhang Z, Liu Z, et al. The value of pulmonary nodule diameter and consolidation/tumor rate in the prediction of lymph node metastasis in early-stage (cT1N0M0) lung adenocarcinoma. Transl Cancer Res, 2021, 10(1): 38-46.
22. Ding N, Mao Y, Gao S, et al. Predictors of lymph node metastasis and possible selective lymph node dissection in clinical stageⅠA non-small cell lung cancer. J Thorac Dis, 2018, 10(7): 4061-4068.
23. Yan S, Wang X, Lv C, et al. Mediastinal micro-vessels clipping during lymph node dissection may contribute to reduce postoperative pleural drainage. J Thorac Dis, 2016, 8(3): 415-421.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Impact factors for early extubation and drainage volume after sublobectomy: A propensity score matching study

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