Decision-Making in Pleural Drainage Following Lung Resection in Children: A Western Pediatric Surgery Research
Jamie K Schnuck1, Shannon N Acker2, Lorraine I Kelley-Quon3
1Department of General Surgery, University of Washington, Seattle, WA, USA.
Insights
Pediatric surgeons often use pleural drains after lung resection, but recent graduates are more likely to omit them. Further research on omitting drains could change practice for children.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Surgical Outcomes
Background:
- Selective omission of pleural drains is safe and beneficial in adults after lung resection.
- Practice patterns for pediatric pleural drainage after lung resection show significant variation.
- Understanding decision-making for pediatric pleural drains is crucial.
Purpose of the Study:
- To survey pediatric surgeons on their decision-making for pleural drain placement after lung resection in children.
- To identify factors influencing the use of pleural drains in pediatric lung surgery.
Main Methods:
- A REDCap survey was distributed to faculty surgeons at 10 institutions in the Western Pediatric Surgery Research Consortium.
- Descriptive statistics and bivariate analyses characterized responses on pleural drain indications and management.
- 96 out of 109 surgeons (88%) responded to the survey.
Main Results:
- Most surgeons agree pleural drains increase post-operative pain, narcotic use, and hospitalization duration.
- Surgeons who completed fellowship within the last 10 years omitted drains after wedge resection more often (45%) than those who completed fellowship over 10 years ago (78%).
- The acceptable rate for unplanned post-operative pleural drain placement when drains were omitted was a mean of 6.3%.
Conclusions:
- The majority of pediatric surgeons currently utilize pleural drainage after lung resection.
- Recent fellowship graduates demonstrate a trend towards omitting pleural drains more frequently.
- Demonstrating low rates of unplanned re-intervention for drain omission may encourage wider adoption in pediatric practice.
Introduction:
Studies of adults undergoing lung resection indicated that selective omission of pleural drains is safe and advantageous. Significant practice variation exists for pleural drainage practices for children undergoing lung resection. We surveyed pediatric surgeons in a 10-hospital research consortium to understand decision-making for placement of pleural drains following lung resection in children.
Methods:
Faculty surgeons at the 10 member institutions of the Western Pediatric Surgery Research Consortium completed questionnaires using a REDCap survey platform. Descriptive statistics and bivariate analyses were used to characterize responses regarding indications and management of pleural drains following lung resection in pediatric patients.
Results:
We received 96 responses from 109 surgeons (88 %). Most surgeons agreed that use of a pleural drain after lung resection contributes to post-operative pain, increases narcotic use, and prolongs hospitalization. Opinions varied around the immediate use of suction compared to water seal, and half routinely completed a water seal trial prior to drain removal. Surgeons who completed fellowship within the past 10 years left a pleural drain after wedge resection in 45 % of cases versus 78 % in those who completed fellowship more than 10 years ago (p = 0.001). The mean acceptable rate of unplanned post-operative pleural drain placement when pleural drainage was omitted at index operation was 6.3 % (±4.6 %).
Conclusions:
Most pediatric surgeons use pleural drainage following lung resection, with recent fellowship graduates more often omitting it. Future studies of pleural drain omission demonstrating low rates of unplanned postoperative pleural drain placement may motivate practice changes for children undergoing lung resection.
Level Of Evidence:
V.
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