title: Pleural tent after upper lobectomy: a randomized study of efficacy and duration of effect.
abstract: BACKGROUND
  The object of this study was to assess the efficay and maximum duration of effect of the pleural tent in reducing the incidence of air leak after upper lobectomy.
  
  
  METHODS
  Two hundred patients who underwent upper lobectomy were prospectively randomized into two groups: 100 patients who underwent an upper lobectomy and a pleural tent procedure (group 1; tented patients) and 100 patients who underwent only an upper lobectomy and not a pleural tent procedure (group 2; untented patients). The preoperative, operative, and postoperative characteristics of both groups were compared. Then multivariate analyses were used to identify factors predictive of prolonged air leaks and their duration. The reduction of incidences of air leak in the two groups was subsequently compared during successive postoperative periods.
  
  
  RESULTS
  No differences were detected between the two groups in terms of preoperative and operative characteristics. A significant reduction occurred in group 1 patients for the mean duration of air leak in days (2.5 vs 7.2 days; p < 0001), the number of days a chest tube was required (7.0 vs 11.2 days; p < 0.0001), the length of postoperative hospital stay in days (8.2 vs 11.6 days; p < 0.0001), and the hospital stay cost per patient (4,110 dollars vs 5,805 dollars; p < 0.0001). Logistic regression analyses showed that not having undergone a pleural tent procedure was the most significant predictive factor of the occurrence and duration of prolonged air leaks. A greater reduction in the duration of air leaks was observed before postoperative day 4 in group 1, and logistic regression analysis showed that having undergone a pleural tent procedure was the most significant predictive factor of air leaks that persisted for less than 4 days.
  
  
  CONCLUSIONS
  Pleural tenting after upper lobectomy was a safe procedure that reduced the duration of air leaks and the hospital stay costs. The benefit from that procedure was achieved before postoperative day 4.
authors.affiliation: Department of Thoracic Surgery, University of Ancona, Ancona, Italy. alexit_2000@yahoo.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.forename: Majed
authors.initials: M
authors.lastname: Al Refai
authors.forename: Marco
authors.initials: M
authors.lastname: Monteverde
authors.forename: Alessandro
authors.initials: A
authors.lastname: Borri
authors.forename: Michele
authors.initials: M
authors.lastname: Salati
authors.forename: Armando
authors.initials: A
authors.lastname: Sabbatini
authors.forename: Aroldo
authors.initials: A
authors.lastname: Fianchini
mesh_terms: D000368:Aged; D006801:Humans; D007902:Length of Stay; D010994:Pleura / Q000601:surgery*; D011013:Pneumonectomy / Q000191:economics; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome