Management of pleural injuries during retroperitoneal surgical procedures.
OBJECTIVE
The necessity of a postoperative chest tube for the treatment of pneumothorax after a radical nephrectomy is controversial.


METHODS
A five-year retrospective study was performed on 91 patients, having undergone a radical nephrectomy. We examined the existence and length of a pleural rent, presence of a postoperative thoracostomy tube, postoperative pneumothorax, postoperative pneumonia, postoperative atelectasis, pain scores, hemoglobin saturation, and length of hospital stay with univariate and multivariate analysis.


RESULTS
Incidence of a pleural rent occurred in 29 (36%) of open radical nephrectomy cases; 4 of the 29 cases had a postoperative thoracostomy tube. There was no significant difference in hemoglobin saturation levels between cases that had no pleural rent, a pleural rent without a thoracostomy tube, and a pleural rent with a postoperative thoracostomy tube. A pleural rent without a postoperative chest tube had significantly lower rates of pain score, atelectasis, pneumonia, pleural effusion, and length of hospital stay compared to individuals with a postoperative chest tube. Patients with a chest tube had a significantly higher incidence of pain, atelectasis, pneumonia, effusion, and length of hospital stay.


CONCLUSIONS
Iatrogenic pleural rents treated without a postoperative chest tube show a significant decrease in postoperative complications of pneumonia and atelectasis, pain score and length of hospital stay. These patients show no significant increases in postoperative complications; therefore, it appears that postoperative chest tube placement after a pleural injury occurs is of no advantage.
Rutledge
Michael
M
Department of Urology, Texas Tech University Health Sciences Center, University Urology Associates, Medical Office Plaza, 3502 9th Street, Ste#260, Lubbock, TX 79415, USA.
Aronoff
David
D
de Riese
Werner
W
Mittemeyer
Bernhard
B
D015505:Chest Tubes; D006801:Humans; D007902:Length of Stay; D009392:Nephrectomy / Q000009:adverse effects; D010147:Pain Measurement; D010994:Pleura / Q000293:injuries*; D011030:Pneumothorax / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications / Q000628:therapy; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies