Impact Of Surgical Technique And Analgesia On Clinical Outcomes After Lung Transplantation

Abstract

Background: Lung transplantation is the ultimate treatment for end stage lung disease. There is paucity of data on the impact of surgical incision and analgesia on clinically relevant outcomes.

Methods: A single centre retrospective study was performed between July 2007 and August 2017 of patients undergoing single or double lung transplantation. Gender, age, indication for lung transplantation, and the three types of surgical access (Thoracotomy (T), Sternotomy (S) and Clamshell (C)) were used, as well as two analgesic techniques: epidural and intravenous opioids. Outcome variables of the study were: Pain scores; Postoperative hemorrhage in the first 24 hours, duration of mechanical ventilation and length of stay at ICU.

Results: 341 patients were identified. Thoracotomy was associated with higher pain scores than Sternotomy (OR 1.66, 95% CI: 1.01;2.74, p: 0.045) and no differences were found between Clamshell and Sternotomy incision.The median blood loss was 800 ml [IQR: 500; 1238], thoracotomy patients had 500 ml [325;818] (p < 0.001). Median duration of mechanical ventilation in Thoracotomy, Sternotomy and Clamshell groups were 19 [11; 37] hours, 34 [IQR 16; 57.5] hours and 27 [IQR 15; 50.5] hours respectively. Thoracotomy group were discharged earlier from ICU (p<0.001).

Conclusions : Thoracotomy access produces less postoperative hemorrhage, duration of mechanical ventilation and lower length of stay in ICU, but higher pain scores and need for epidural analgesia.