ObjectiveTo summarize the clinical experience in the prevention and treatment of novel coronavirus (2019-nCoV, SARS-CoV-2) disease (COVID-19) in the department of thoracic surgery of large grade A tertiary hospitals in Wuhan, and to provide feasible clinical practice strategies.MethodsThe clinical data of 41 COVID-19 patients in the department of thoracic surgery of 7 large grade A tertiary hospitals in Wuhan from December 15, 2019 to February 15, 2020 were analyzed retrospectively. There were 20 surgical patients (10 males and 10 females at an average age of 54.35±10.80 years) and 21 medical personnel (7 males and 14 females at an average age of 30.38±6.23 years).ResultsThe main clinical manifestations of COVID-19 patients were fever (70.73%) and cough (53.66%). Normal or reduced peripheral white blood cells and reduced lymphocyte counts were found in the COVID-19 patients, and some patients may have increased C-reactive protein. COVID-19 patients showed limited ground-glass opacities in early chest CT, which was evident in the edge band of lung. The disease could further develop into multiple pulmonary infiltrations, and pulmonary consolidation was found in severe cases. At the time of confirmed diagnosis, most of the medical personnel were ground-glass shadows and unilateral lesions, and even no obvious abnormalities were found in the lungs. The diagnosed COVID-19 patients were transferred to the isolation ward immediately and treated according to the "Diagnosis and Treatment Program of Novel Coronavirus Pneumonia", which was released by the National Health Commission of the People's Republic of China. At the end of follow-up on February 20, 2020, seven surgical patients (35.00%) were discharged and seven (35.00%) were dead, 13 (61.90%) medical personnel were discharged and no death was found.ConclusionsOf all COVID-19 patients in the department of thoracic surgery of hospitals in Wuhan, the proportion of severe degree and mortality in surgical patients are significantly higher than that of the general population, and medical personnel are prone to nosocomial infections. Early oxygen therapy and respiratory support may improve prognosis. During the epidemic period of COVID-19, elective or limited surgery is suggested to be postponed and the indications for emergency operation should be strictly controlled. Emergency operation is suggested to be treated in accordance with tertiary prevention. On the consideration of specialty in the department of thoracic surgery, all people of the ward should be carefully investigated for infection once one case is confirmed with COVID-19. Early detection, isolation, diagnosis, and treatment are the best preventive measures to improve the prognosis of COVID-19.
ObjectiveTo explore the training mode for improving the innovative scientific research ability of postgraduates of thoracic surgery.MethodsTwenty-two postgraduate students enrolled in the Department of Thoracic Surgery, Ruijin Hospital from September 2016 to June 2019 were targeted for training, and the teachers were 13 doctors in our department. Training methods included grant-based learning, formative learning and translational medical learning. In addition to the postgraduate education provided by the medical school, the training content also included more than 50 lectures about thoracic surgery, including surgical video explanation, perioperative management of thoracic surgery, interpretation of clinical guidelines, and intensive reading of the literature; it also included half-year clinical internship, 100 surgical operations and management of 5 medical beds in ward.ResultsClinical ability of the postgraduates were improved. Six postgraduate students enrolled in 2016 graduated successfully. They published 15 SCI papers and won more than 20 awards.ConclusionCultivating postgraduates of thoracic surgery oriented by innovative scientific research ability is conducive to the comprehensive understanding of thoracic diseases and the ability of innovative translation research.
Objective To investigate the diagnosis and treatment of pulmonary thromboembolism (PTE) after thoracotomy. Methods We analyzed the clinical data of 10 patients with PTE after thoracotomy treated from January 2011 to March 2015. Among them were 8 males and 2 females, with their age ranging from 51 to 73 years old, averaging 61. Six patients had lung cancer lobectomy, and 4 had esophagus carcinoma resection. All the 10 patients suffered sudden shortness of breath, chest pain and palpitation within the first 40 hours to 128 hours after surgery, and the physical examinations revealed tachypnea, drop of blood pressure and tachycardia. The PTE diagnosis was confirmed after using echocardiography, three-dimensional imaging of CT pulmonary angiography. All the patients accepted the treatment combination of low molecular weight heparin and warfarin. Results All the patients were cured without complications like chest or wound bleeding. Follow-up checks 3 months after the surgery showed no relapses. Conclusions Thoracotomy patients are of high risks of PTE. The diagnosis should be based on imaging examinations. Treatment combination of low molecular weight heparin and warfarin has a remarkable effect in treating PTE patients after thoracotomy, which also has a low rate of bleeding complications.
Objective To evaluate the pathways for improving the operational efficiency of medical teams, thereby providing micro-level empirical evidence for the refined management and high-quality development of public hospitals. MethodsBased on panel data from nine surgical teams in the Department of Thoracic Surgery at Sichuan Cancer Hospital from 2021 to 2024, this study employed the data envelopment analysis (DEA) with the BCC model to assess static efficiency, including technical efficiency (TE), scale efficiency (SE), and overall efficiency (OE). The Malmquist index was used to analyze the dynamic total factor productivity (TFP) and its decomposition into efficiency change (EC) and technology change (TC). Input indicators were the number of physicians and the number of open beds. Output indicators included the proportion of surgical patients, the proportion of grade Ⅳ surgeries, and the average length of stay (reciprocally transformed for positive orientation). Results The mean OE of all medical teams showed a continuous upward trend, while the mean SE exhibited a “V-shaped” pattern, initially decreasing and then increasing. The most significant growth was observed in mean TE, which was the primary driver of the OE improvement. All medical teams achieved positive TFP growth, with TC values greater than 1.000 across all teams, indicating that technological innovation was the core engine of efficiency enhancement. However, EC showed a divergent trend among the teams. Conclusion Public hospital performance appraisal policies effectively guide technological upgrading of medical teams through indicators such as “proportion of discharged patients undergoing surgery” and “proportion of grade Ⅳ surgeries”. However, issues of hospital resource mismatch and SE differentiation persist. It is necessary to establish specialized operation groups for dynamic resource monitoring and construct a “technological upgrading, scale adaptation, and management innovation” triangular balanced system to achieve a sustainable mechanism for maximizing healthcare resource input-output.
Quality control of general thoracic surgery contains many links including the qualification and technical conditions of medical institutions, preoperative diagnostic system, surgery, postoperative management, pathological diagnosis and follow-up. Standards of quality control should be based on evidence-based medicine, and general rules with detailed criteria. As one of the core concepts of quality control, fine management is ought to strictly follow clinical practice guideline of thoracic surgery, to be clear with quality standards of each key link in clinical pathway, and to improve the clinical quality control system that combines self-evaluation and supervision and inspection.
ObjectiveTo discuss the clinical characteristics and the management of major complications after thoracic surgery.MethodsRetrospective research was conducted on 15 213 patients who underwent thoracic surgery from January 2008 to September 2018 in our hospital. Thirty-six (0.24%) patients died of postoperative complications. Based on whether major complications such as severe pulmonary pneumonia and other 13 complications were presented postoperatively, the patients were divided into a complication group (n=389, 294 males and 95 females, aged 61.93±10.23 years) and a non-complication group (n=14 785, 8 636 males and 6 149 females, aged 55.27±13.21 years) after exclusion of unqualified patients. The age, gender distribution, diagnosis, surgical approach, postoperative hospital stay, in-hospital costs and other clinical data were analyzed. And the treatment and outcomes of the complications were summarized.ResultsThe age, proportion of male, malignancy and esophageal diseases, postoperative hospital stay and in-hospital costs in the complication group were significantly more or higher than those in the non-complication group (P<0.05). The top three causes of death among the 36 deaths were pulmonary embolism (PE, 25.00%), severe pulmonary pneumonia (16.67%) and acute respiratory failure (16.67%), respectively. The top five complications among the severe complication group were pulmonary pneumonia (24.73%), pleural space (19.83%), anastomotic leak (17.48%), pulmonary atelectasis (11.51%) and PE (6.18%).ConclusionThoracic surgeons should recognize patients with high risk of severe complications preoperatively based on clinical characteristics and perform multi-disciplinary treatment for severe complications.
Abstract： Appropriate prophylactic administration of antibiotics for thoracic and cardiovascular surgical procedure can reduce postoperative morbidity and decrease the overall cost due to infections. Prophylactic antibiotics should be given within 30 minutes preceding incision intravascularly. Serum levels of free drug above the minimal inhibitory concentration (MIC) for common contaminating bacteria should be maintained for the entire surgical period. Prophylactic antibiotics after operation are useless for patients without risk factors predisposing to postoperative infection. Heart and(or) lung transplant patients should be given antiviral and antifungal prophylaxis. Selection of antibiotics must be based on the pharmacokinetic, pharcodynamic and pharmacoeconomic properties of antibiotics and features of surgery. The policy of antibiotic prophylaxis must be modified in response to alterations in antibiotic resistance pattern which is constantly changing in hospital.
ObjectiveTo investigate the reliability and validity of Short-Form 36 Health Survey Scale (SF-36) for evaluating quality of life (QOL) of thoracic surgery patients in a specific regional medical center,and improve care and nursing plan for these patients. MethodsNinety-five patients who were admitted in Department of Thoracic Surgery of West China Hospital from March to May 2012 were enrolled in this study. Ninety-four patients finished a valid questionnaire study including 68 male and 26 female patients with their average age of 62.0±13.0 years. Preoperative diagnosis was squamous cell lung cancer in 8 patients,lung adenocarcinoma in 6 patients,small cell lung cancer in 1 patient,esophageal cancer in 12 patients and undefined lung mass in 67 patients. Postoperative diagnosis was squamous cell lung cancer in 39 patients, lung adenocarcinoma in 28 patients,small cell lung cancer in 8 patients,esophageal cancer in 12 patients,pulmonary tuberculosis in 3 patients and inflammatory pseudo-tumor in 4 patients. Chinese edition of SF-36 was used to evaluate patients' QOL. Cronbach's coefficients (α) and split-half reliability were used to assess its reliability. Its validity was assessed through factor analysis. ResultsCronbach's coefficients (α) of SF-36 were as followed:Physical Functioning (PF) 0.721,Role-Physical (RP) 0.859,General Health (GH) 0.721,Vitality (VT) 0.899,Social Functioning (SF) 0.852,Role-Emotional (RE) 0.872,and Mental Health (MH) 0.598. Split-half reliability of each part was PF 0.725,RP 0.784,GH 0.758,VT 0.749,SF 0.745,RE 0.740,and MH 0.426. Nine principal components were extracted by factor analysis and generally reflected the 8 dimensions of SF-36,which was correspondent to the SF-36 structure. ConclusionSF-36 scale can be used to measure QOL of thoracic surgery patients with good reliability and validity.
With the continuous advancement of internet technology and the improvement of internet literacy among the general population, the concept of online-offline integration in internet hospitals has gradually gained acceptance and has been applied and developed both domestically and internationally. In thoracic surgery, the applicability of this model lies in enhancing efficiency and delivering comprehensive, diversified, and personalized medical services to address complex and severe conditions. However, challenges such as hardware limitations and diagnostic/treatment risks persist during the implementation of internet hospitals. Through future in-depth and localized research, the online-offline integration of internet hospitals is expected to undergo further development and refinement. This progress will facilitate its integration into clinical practice in thoracic surgery, ultimately providing patients with improved medical care services.
It has been absent from an accepted criteria for normalization and quality control of the thoracic surgery until now. The ideal assessing instrument which will be used to evaluate the technical skills and surgical procedures should present a few vital characterizations below: objectivity, speciality in the content, detailed structure, and quantifiability. Objective structured assessment of technical skills (OSATS) has developed as a reliable method of surgical skills measurement. This article focuses on the history of OSATS and its prospect in the thoracic surgery area by reviewing relevant literatures.