Preservation of pleural integrity during coronary artery bypass surgery affects respiratory functions and postoperative pain: a prospective study.
OBJECTIVE
To evaluate the role of preserved pleural integrity in postoperative pain and respiratory functional status in patients undergoing coronary revascularization.


METHODS
Two hundred forty patients undergoing on-pump coronary artery bypass grafting between March 2004 and February 2005 were included in the present study. The patients were prospectively randomized and divided into either an opened pleura (OP) group (n=120, patients with an OP) or a closed pleura (CP) group (n=120, patients whose pleural integrity was preserved). Preoperative patient characteristics were similar. Postoperative respiratory functions were compared between the groups by chest x-rays, respiratory functional tests and arterial blood gas analyses. Postoperative pain was compared by using a multidimensional pain score. All the tests were examined by the same blinded clinician.


RESULTS
The mean age of the patients was 60.4+/-8.8 years. Postoperative bleeding and the duration of hospital stay were markedly higher in the OP group than in the CP group. The incidences of atelectasis and pleural effusion were also significantly higher in the OP group (P<0.01). Respiratory functions and postoperative pain scores were better in the CP group (P<0.01 and P=0.008, respectively).


CONCLUSIONS
Preserving pleural integrity has beneficial effects on the respiratory functions and postoperative pain after coronary revascularization. The preservation of pleural integrity results in better respiratory function, decreased hospital stay and cost, and as a consequence, a better surgical outcome.
Oz
Bilgehan Savas
BS
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Turkey.
Iyem
Hikmet
H
Akay
Hakki Tankut
HT
Yildirim
Vedat
V
Karabacak
Kubilay
K
Bolcal
Cengiz
C
Demirkiliç
Ufuk
U
Tatar
Harun
H
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D010994:Pleura / Q000601:surgery; D010996:Pleural Effusion / Q000517:prevention & control; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000517:prevention & control; D012129:Respiratory Function Tests; D012143:Respiratory Physiological Phenomena