Cost analysis and evaluation of risk factors for postoperative pneumonia after thoracic and cardiovascular surgery: a single-center study

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-06-27 4 2 56 62 10.26663/cts.2019.00011 77 article Cost analysis and evaluation of risk factors for postoperative pneumonia after thoracic and cardiovascular surgery: a single-center study Aysegul Inci Sezen 1 Celal Bugra Sezen 2 Sevgi Sokulmez Yildirim 3 Murat Dizbay 4 Fatma Ulutan 4 Department of Infections Diseases and Clinical Microbiology, Haseki Research and Education Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Research and Education Hospital, Istanbul, TurkeyAnkara Occupational and Environmental Diseases Hospital, Ankara, TurkeyDepartment of Infections Diseases and Clinical Microbiology Faculty of Medicine, Gazi University, Ankara, TurkeyBackground: Postoperative pneumonia increases costs associated with inpatient stay, treatment, laboratory testing, and imaging, thereby increasing total healthcare costs. The aim of this study was to determine risk factors in patients who develop pneumonia after thoracic and cardiovascular surgery, evaluate relationships between these risk factors and cost, and conduct a cost analysis of postoperative pneumonia. Materials and Methods: 111 patients who underwent major thoracic or cardiovascular surgery between June 2009 and March 2014 were evaluated retrospectively. Patients who developed postoperative pneumonia (p = 37) were compared with those who had no postoperative complications (p = 74). Results: 40 men and 71 women were included in the study. Mean length of hospital stay was 21 days for patients with pneumonia versus 10 days for patients without pneumonia (p < 0.001). Significant risk factors for postoperative pneumonia were Charlson Comorbidity Index > 2, steroid use, high ASA score, presence of nasogastric tube, peripheral/central venous catheterization, postoperative heart failure/acute kidney failure, total parenteral nutrition, late postoperative mobilization, and prolonged ventilation and intubation (p < 0.05). Postoperative pneumonia was associated with significantly higher mortality rate and total cost (p < 0.001 for both). The mean cost of treatment for patients with and without postoperative pneumonia was 8211.7 TL and 3917.5 TL, respectively (p < 0.001). There were statistically significant differences between the two groups in the costs of surgery, radiology, antibiotics, and cultures (p < 0.001 for all). Correlation analysis between risk factors and cost revealed that prolonged intubation, late mobilization, and lack of respiratory rehabilitation exercises were associated with higher costs (p < 0.05). Conclusions: Postoperative pneumonia significantly increases costs. Identifying and mitigating these factors will reduce both the incidence of infection and the associated costs. Because infection control measures help avoid infection and thereby infection-related costs, it is critically important to support infection control activities and prevent nosocomial infections. https://cts.tgcd.org.tr/pdf.php?id=77 cost analysispneumoniaprognostic factors eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-06-27 4 2 63 69 10.26663/cts.2019.00012 78 article Blood pleurodesis for air leak after pulmonary resection Ali Murat Akçıl 1 Merve Hatipoğlu 1 Levent Cansever 1 Deniz Sansar 1 Celal Buğra Sezen 1 Mehmet Ali Bedirhan 1 Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, İstanbul, TurkeyBackground: Blood pleurodesis procedures were generally performed for patients with prolonged air leakage due to pneumothorax. This study investigates the use of blood pleurodesis in patients with prolonged air leak after lung resection and the variables affecting its success. Materials and Methods: A total of 493 patients who underwent anatomical lung resection for nonsmall cell lung cancer between January 2012 and December 2016 were evaluated retrospectively. 68 (13.7%) patients who underwent blood pleurodesis were included the study group. The success rate of the procedure was evaluated according to age, gender, side and type of the surgery, histopathology, and the expansion of the lungs and air leakage. Results: The success rate was not related to age, sex, side of the operation, histopathology, and type of the resection, while it was found to be statistically significant for the air leakage score (p < 0.001). The procedure was successful in 46 (67.6%) patients and failed in 22 (32.3%) patients. Conclusions: The blood pleurodesis is a safe, effective and low cost method for treatment of postoperative air leakage in patients with anatomical lung resection for primary lung carcinoma. https://cts.tgcd.org.tr/pdf.php?id=78 blood pleurodesisautologous blood pleurodesisprolonged air leakagelung resection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-06-27 4 2 70 75 10.26663/cts.2019.00013 79 article Clinical and biochemical parameters for the selective use of chest computed tomography in pediatric blunt trauma patients Demet Yaldız 1 Murat Anıl 2 Mustafa Onur Öztan 3 Funda Cansun Yakut 4 Mehmet Sadık Yaldız 1 Department of Thoracic Surgery, Celal Bayar University, Faculty of Medicine, Manisa, TurkeyDepartment of Emergency of Pediatrics, Tepecik Training and Research Hospital, İzmir, TurkeyDepartment of Pediatric Surgery, Katip Çelebi University, Faculty of Medicine, İzmir, TurkeyDepartment of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, TurkeyBackground: The aim of the present study was to investigate the predictive role of clinical and biochemical parameters whether thoracic CT scan rate could be decreased in high energy blunt thoracic trauma in children. Materials and Methods: This retrospective study included 15 pediatric patients who received chest computed tomography, out of 165 consecutive high-energy pediatric trauma patients admitted to our pediatric emergency department within one year. 15 Patients were divided into two groups. Normal tomography findings (Group I; n = 8) and revealing thoracic pathology (Group II; n = 7). The groups were compared in terms of age, gender, weight, type of trauma, fever, pulse and respiratory rate per minute, systolic blood pressure, peripheral blood oxygen saturation and biochemical parameters. Glasgow Coma Scale, Pediatric Trauma Score, Modified Trauma score, and Injury Severity Score were also calculated and evaluated. Results: There was no statistically significant difference between the two groups in terms of age, gender, weight, type of trauma, fever, respiratory rate, systolic blood pressure, and pulse rate (p > 0.05), whereas a statistically significant difference was determined between two groups with respect to peripheral blood oxygen saturation (p = 0.013), white blood cell count (p = 0.008), blood glucose (p = 0.003), alanine transaminase (p = 0.033), and aspartate transaminase (p = 0.012). When the trauma scores were evaluated; Glasgow Coma Score (p < 0.001), Pediatric Trauma Score (p = 0.002), and Modified Trauma Score (p < 0.001) were found to be statistically low in the second group while Injury Severity Score (p = 0.001) was higher. Conclusions: Peripheral blood oxygen saturation, white blood cell count, blood glucose, alanine transaminase, aspartate transaminase, and Glasgow Coma Score, Pediatric Trauma Score, Modified Trauma Score, Injury Severity Score shall be predictive parameters for a thoracic pathology and need for chest computed tomography. https://cts.tgcd.org.tr/pdf.php?id=79 pediatric blunt thoracic traumacomputerized chest tomographypredictive parameter eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-06-27 4 2 76 80 10.26663/cts.2019.00014 80 article Advantages of surgical approach for multiple rib fractures Serdar Ozkan 1 Ozgur Omer Yildiz 2 Department of Thoracic Surgery, Medova Private Hospital, Konya, TurkeyDepartment of Thoracic Surgery, Yildirim Beyazit University, Faculty of Medicine, Ankara, TurkeyBackground: In this article, we present our study of surgical treatment of multiple rib fractures, which reduced pulmonary complications and recovery time. Materials and Methods: From 2014 to 2016, a total 14 cases (8 male, 6 female, average age 59.6 years (range: 29-76)) who underwent plate fixation were included in the study. The cases were evaluated according to their demographic features, symptoms, radiological scans, numbers and locations of rib fractures, surgical approach performed and its results. Results: The average number of fractures is 7.5 costa (range: 3-16). Multiple rib fractures were in the left hemithorax in nine cases, in the right hemithorax in two cases and were bilateral in three cases. While all cases had additional pulmonary pathology, 12 cases had different system pathologies. Ten out of 14 cases had flail chest. None of the cases underwent mechanic ventilation in the preoperative stage. Following the planning of their medical treatment based on their clinical condition, they underwent tube thoracotomy. Plate fixation surgery was performed for all cases in an average of one day. The average number of plates used is 3.2 plates (range: 2-5). In four cases, postoperative complications were observed. The average length of stay in hospital in the postoperative period was 7.6 days (range: 3-14). Conclusions: Rib fractures, which often occur following blunt thoracic trauma, usually heal on their own and treatment is based on the symptoms. However, multiple rib fractures can cause morbidity such as increase in pulmonary complications, prolonged healing process, and reduced life quality or mortality due to complications. While there is no consensus on a specific treatment for rib fractures, open reduction and fixation in rib fractures, in particular those caused by blunt thoracic trauma, is a method of treatment with significant benefits including increase the life quality of the patient, and decrease in potential complications, length of stay in the hospital and cost. https://cts.tgcd.org.tr/pdf.php?id=80 thoracic traumamultiple rib fracturesrib fixation eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-06-27 4 2 81 88 10.26663/cts.2019.00015 81 article Prognostic factors and long-term survival outcomes of thymic tumors Cemal Aker 1 Cem Emrah Kalafat 2 Celal Buğra Sezen 1 Yasar Sonmezoglu 1 Levent Cansever 1 Muzaffer Metin 1 Celalettin Ibrahim Kocaturk 3 Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, İstanbul, TurkeyDepartment of Thoracic Surgery, Mardin State Hospital, Mardin, TurkeyDepartment of Thoracic Surgery, Istinye Faculty of Medicine, Liv Hospital Ulus, Istanbul, TurkeyBackground: Thymic masses are the most common anterior mediastinal neoplasms. In this study, we analyzed the histopathologic subgroups and stages of thymic tumors, evaluated mortality and morbidity, and identified the factors affecting survival in patients who underwent thymectomy due to thymic tumors. Materials and Methods: 159 patients who underwent surgery in our center for anterior mediastinal mass between January 2005 and December 2016 were analyzed retrospectively. Of the patients who had thymectomy procedures, 76 with thymoma or thymic carcinoma were included in the study. Results: The mean age of the patients was 51 ± 14.3 (18-77) years. Forty-seven patients (61.8%) were male, and 29 (38.2%) were female. Fourteen of the patients (18.4%) were aged 65 years or older. Sixteen patients (21.1%) also had myasthenia gravis. The diagnosis was thymoma in 67 patients (85.2%) and thymic carcinoma in 9 patients (11.8%). There were no statistically significant differences in survival outcomes based on Masaoka or World Health Organization (WHO) thymoma stage. In terms of the extent of resection, survival time was 83.4 ± 10.5 months for patients who had simple thymectomy and 124 ± 5.4 months among patients who underwent extended or maximal thymectomy (p = 0.043). Conclusions: Our findings suggest that thymoma stage and histopathologic subgroup were not prognostic factors, while extended resection was the most significant factor in survival. https://cts.tgcd.org.tr/pdf.php?id=81 thymomaanterior mediastinal massthoracoscopic surgeryprognostic factors eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-06-27 4 2 89 91 10.26663/cts.2019.00016 82 article How to remove giant mediastinal goiter from left to right? Yucel Akkas 1 Barış Hekimoğlu 1 Büşra Özdemir 1 Bulent Kocer 1 Tanju Tütüncü 2 Department of Thoracic Surgery, Ankara Numune Research and Training Hospital, Ankara, TurkeyDepartment of General Surgery, Ankara Numune Research and Training Hospital, Ankara, TurkeyWe present a 57-year-old woman who has a giant mediastinal goiter, which lies down from cervical zone to right posterior mediastinum. On physical examination mediastinal goiter was nonpalpable. Giant mediastinal goiter was removed by right lateral thoracotomy, cervical collar incision and partial sternotomy. Pathology was reported as a multinodular goiter. We cannot perform VATS (video-assisted thoracoscopy) due to tight adhesion of the pleura. With the difference of literature partial sternotomy can be added to the transcervical and lateral thoracotomy approach for ease of removing giant posterior mediastinal goiters which lie down left cervical to the right posterior mediastinum. https://cts.tgcd.org.tr/pdf.php?id=82 partial sternotomyposterior mediastinal goiterthoracotomytranscervical approach eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-06-27 4 2 92 94 10.26663/cts.2019.00017 83 article Mass lesion in the neighborhood of the rib and vertebra: extramedullary hematopoiesis Oğuzhan Turan 1 Ömer Faruk Demir 1 Ömer Önal 1 Leyla Hasdıraz 1 Fahri Oguzkaya 1 Department of Thoracic Surgery, Erciyes University Faculty of Medicine, Kayseri, TurkeyExtramedullary hematopoiesis is the production of blood outside of the bone marrow. While it may normally arise in the liver and spleen during the fetal period, it is considered as a compensatory mechanism in adults. Extramedullary hematopoiesis is seen in patients with chronic anemia such as thalassemia, hereditary spherocytosis, most commonly in the liver and spleen, as in the fetal period. On the other hand, intrathoracic hematopoiesis is quite rare. The aim of this study is to discuss this rare condition. A 42-year-old male patient was examined for a mass incidentally detected in the lung during his routine follow-ups. In our patient with no history of diseases except for external thalassemia intermedia, the scattered homogeneous density increments on the posteroanterior chest x-ray were evaluated and his thoracic tomography revealed soft-tissue increments of 7.5 cm in the vicinity of the rib and vertebrae. Extramedullary hematopoiesis should be kept in mind in the differential diagnosis of patients with bilateral masses by the contiguity of the rib and vertebrae. Hematological studies should be conducted in this regard. https://cts.tgcd.org.tr/pdf.php?id=83 extramedullary hematopoiesisthalassemia intermediaposterior mediastinal mass eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-06-27 4 2 95 98 10.26663/cts.2019.00018 84 article Rare mediastinal complications of dental procedures Ulas Kumbasar 1 Recep Oktay Peker 2 Metin Demircin 1 Riza Dogan 1 Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, TurkeyDepartment of Cardiovascular Surgery, Hacettepe University School of Medicine, Ankara, TurkeyDental extraction is a frequently performed procedure in daily routine. Although this procedure is associated with a low complication rate, it has the potential to cause lethal complications such as head and neck emphysema, pneumomediastinum, pharyngeal abscess, septic thrombophlebitis of internal jugular vein, descending necrotizing mediastinitis, peribronchovascular inflammation of the lung parenchyma, and septicaemia. Conservative management is sufficient in majority of patients with emphysema and/or pneumomediastinum. However, treatment of pharyngeal abscess, mediastinitis and mediastinal abscess cannot be achieved with solely antibiotic administration and surgical drainage is necessary in most of the cases. In this report, we present three cases; two cases of pneumomediastinum and one case with severe deep neck inflammation, thrombophlebitis of jugular vein, mediastinitis and empyema occurred following molar tooth extraction by using air-tribune drills. Two cases without infectious complications were treated conservatively while the other patient was treated surgically. Complete resolution was achieved in all patients during follow-up. https://cts.tgcd.org.tr/pdf.php?id=84 dental extractionpneumomediastinummediastinitis eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-06-27 4 2 99 102 10.26663/cts.2019.00019 85 article A rare case of primary synovial sarcoma localized in the thoracic inlet Celal Bugra Sezen 1 Mahmut Gulgosteren 2 Leyla Memis 3 Abdullah Irfan Tastepe 4 Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey Department of Thoracic Surgery, Medicana International Hospital, Ankara, TurkeyDepartment of Pathology, Gazi University School of Medicine, Ankara, TurkeyDepartment of Thoracic Surgery, Gazi University School of Medicine, Ankara, TurkeyA 33-year-old male patient was complaining about shoulder pain and swelling in his neck. The computed tomography of the patient revealed a mass lesion extending from the supraclavicular region to the upper level of the aortic arch. The patient was operated with the Grunenwald incision approaching from the anterior. The mass was separated from the tissues and totally excised. The histopathological examination reported a biphasic synovial sarcoma. Here we evaluated a very rare case of primary synovial sarcoma in the context of the literature, localized at the thoracic inlet and excised by the Grunenwald incision. https://cts.tgcd.org.tr/pdf.php?id=85 Grunenwald insicionbiphasic synovial sarcomathoracic inletsarcomaspindle cell tumors eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-06-27 4 2 103 105 10.26663/cts.2019.00120 86 article Giant lipoma of the chest wall Gonul Gulmez 1 Omer Faruk Demir 1 Omer Onal 1 Leyla Hasdiraz 1 Fahri Oguzkaya 1 Department of Thoracic Surgery, Erciyes University Faculty of Medicine, Kayseri, TurkeyChest wall tumors may originate from the skin, muscles, adipose tissue, nerves and blood vessels, bone and cartilage tissue. Primary malignant tumors of the chest wall are rare. When contextualized, soft tissue stands out as the major origin of primary chest wall tumors. Lipomas, one of the most common benign soft tissue lesions, may mimic malignant masses with their clinical and radiological manifestations. We aimed to present a case of giant lipoma with the complaint of severe pain with the review of the literature. https://cts.tgcd.org.tr/pdf.php?id=86 chest wall tumorsgiant lipomamalignancy