Short-term perioperative treatment with ambroxol reduces pulmonary complications and hospital costs after pulmonary lobectomy: a randomized trial.
OBJECTIVE
To assess in a randomized clinical trial the influence of perioperative short-term ambroxol administration on postoperative complications, hospital stay and costs after pulmonary lobectomy for lung cancer.


METHODS
One hundred and forty consecutive patients undergoing lobectomy for lung cancer (April 2006-November 2007) were randomized in two groups. Group A (70 patients): ambroxol was administered by intravenous infusion in the context of the usual therapy on the day of operation and on the first 3 postoperative days (1000 mg/day). Group B (70 patients): fluid therapy only without ambroxol. Groups were compared in terms of occurrence of postoperative complications, length of stay and costs.


RESULTS
There were no dropouts from either group and no complications related to treatment. The two groups were well matched for perioperative and operative variables. Compared to group B, group A (ambroxol) had a reduction of postoperative pulmonary complications (4 vs 13, 6% vs 19%, p=0.02), and unplanned ICU admission/readmission (1 vs 6, 1.4% vs 8.6%, p=0.1) rates. Moreover, the postoperative stay and costs were reduced by 2.5 days (5.6 vs 8.1, p=0.02) and 2765 Euro (2499 Euro vs 5264 Euro, p=0.04), respectively.


CONCLUSIONS
Short-term perioperative treatment with ambroxol improved early outcome after lobectomy and may be used to implement fast-tracking policies and cut postoperative costs. Nevertheless, other independent trials are needed to verify the effect of this treatment in different settings.
Refai
Majed
M
Department of Thoracic Surgery, Umberto I Regional Hospital Ancona, Italy. majedit@yahoo.com
Brunelli
Alessandro
A
Xiumé
Francesco
F
Salati
Michele
M
Sciarra
Valeria
V
Socci
Laura
L
Di Nunzio
Luca
L
Sabbatini
Armando
A
D000368:Aged; D000551:Ambroxol / Q000008:administration & dosage*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics / Q000601:surgery*; D008297:Male; D019990:Perioperative Care / Q000191:economics; D011013:Pneumonectomy / Q000009:adverse effects* / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D016896:Treatment Outcome
D011663:Pulmonary Surfactants; D000551:Ambroxol