Clinical features and outcomes of thoracic surgery patients during the COVID-19 pandemic.

OBJECTIVES: The goal of this study was to describe the clinical features and outcomes of thoracic surgery patients during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Thirty-five patients were treated at the 12 de Octubre University Hospital in Madrid between 1 March 2020 and 24 April 2020 during the COVID-19 pandemic. Patient demographics, surgical procedures, complications, COVID-19 symptoms and outcomes were recorded. A protocol was introduced to reduce the risk of operating on patients with COVID-19, including symptom screening, a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 and computed tomography scans of the chest. Surgical activity changed significantly during this time, from an initial period of near-normal activity, through an emergency-only period and finally a recovery period when some oncological surgical cases were restarted. Selection criteria for surgical patients are also described. RESULTS: A total of 34 patients underwent surgery during the pandemic period. We performed 22 lung resections (11 lobectomies and 11 sublobar resections). No hospital deaths were recorded. An elective surgery patient and an emergency surgery patient were diagnosed with COVID-19 (5.88%). The former died within 30 days after surgery. CONCLUSIONS: Severe acute respiratory syndrome coronavirus 2 represents a tremendous limitation for thoracic surgical practice. Preoperative practices to exclude asymptomatic cases infected with the virus allowed us to perform thoracic surgical procedures.

Trombosis en el muñón arterial de cirugías de resección pulmonar: análisis de su presentación clínica, tratamiento y evolución / Arterial Stump Thrombosis after Lung Resection Surgery: Clinical Presentation, Treatment and Progress

Objetivo: Determinar la prevalencia de trombosis de muñón arterial (TMA) en cirugías de resección pulmonar por carcinoma broncogénico, y describir su evolución radiológica y tratamiento. Material y métodos: Estudio observacional y retrospectivo de casos de TMA detectados mediante angiotomografías con contraste intravenoso (TAC). La comparación de variables clínicas, radiológicas, y el análisis de supervivencia mediante curvas de Kaplan-Meier, se realizó planteando 3 grupos: pacientes con TMA, pacientes con tromboembolismo pulmonar (TEP) y pacientes sin TMA ni TEP. Resultados: Se detectaron 9 TMA en 473 cirugías (1,9%), 6 de ellas en el lado derecho (67% de las TMA), con una mediana de tiempo de detección desde la cirugía de 11,3 meses (rango intercuartílico 2,7-42,2 meses). Salvo el número de TAC en pacientes con TMA comparados con el grupo sin TEP ni TMA, y la recidiva tumoral en pacientes con TEP en comparación con los restantes 2 grupos, no se encontraron diferencias estadísticamente significativas en las características basales ni en las oncológicas. Igualmente no se encontraron diferencias en el análisis de supervivencia. Conclusiones: En nuestra serie, la TMA fue una patología infrecuente que tendió a localizarse en las cirugías del lado derecho, y cuya detección a lo largo del tiempo fue variable. No se asoció a factores de riesgo previos a la cirugía ni tuvo predisposición en relación con la estirpe histológica, estadificación oncológica o recidiva tumoral

Objective: To determine the prevalence of arterial stump thrombosis (AST) after pulmonary resection surgery for lung cancer and to describe subsequent radiological follow-up and treatment. Material and methods: Observational, descriptive study of AST detected by computerized tomography angiography (CT) using intravenous contrast. Clinical and radiological variables were compared and a survival analysis using Kaplan-Meier curves was performed after dividing patients into 3 groups: patients with AST, patients with pulmonary embolism (PE), and patients without AST or PE. Results: Nine cases of AST were detected after a total of 473 surgeries (1.9%), 6 of them in right-sided surgeries (67% of AST cases). Median time to detection after surgery was 11.3 months (interquartile range 2.7-42.2 months), and range 67.5 months (1.4-69.0 months). Statistically significant differences were found only in the number of CTs performed in AST patients compared to those without AST or PE, and in tumor recurrence in PE patients compared to the other 2 groups. No differences were found in baseline or oncological characteristics, nor in the survival analysis. Conclusions: In this series, AST prevalence was low and tended to occur in right-sided surgeries. Detection over time was variable, and unrelated to risk factors previous to surgery, histopathology, and tumor stage or recurrence. AST had no impact on patient survival

Arterial Stump Thrombosis after Lung Resection Surgery: Clinical Presentation, Treatment and Progress. / Trombosis en el muñón arterial de cirugías de resección pulmonar: análisis de su presentación clínica, tratamiento y evolución.

OBJECTIVE: To determine the prevalence of arterial stump thrombosis (AST) after pulmonary resection surgery for lung cancer and to describe subsequent radiological follow-up and treatment. MATERIAL AND METHODS: Observational, descriptive study of AST detected by computerized tomography angiography (CT) using intravenous contrast. Clinical and radiological variables were compared and a survival analysis using Kaplan-Meier curves was performed after dividing patients into 3 groups: patients with AST, patients with pulmonary embolism (PE), and patients without AST or PE. RESULTS: Nine cases of AST were detected after a total of 473 surgeries (1.9%), 6 of them in right-sided surgeries (67% of AST cases). Median time to detection after surgery was 11.3 months (interquartile range 2.7-42.2 months), and range 67.5 months (1.4-69.0 months). Statistically significant differences were found only in the number of CTs performed in AST patients compared to those without AST or PE, and in tumor recurrence in PE patients compared to the other 2 groups. No differences were found in baseline or oncological characteristics, nor in the survival analysis. CONCLUSIONS: In this series, AST prevalence was low and tended to occur in right-sided surgeries. Detection over time was variable, and unrelated to risk factors previous to surgery, histopathology, and tumor stage or recurrence. AST had no impact on patient survival.

Evolución y complicaciones del traumatismo torácico / Evolution and Complications of Chest Trauma

Objetivo: Describir las características clínicas y los factores de riesgo de los pacientes con traumatismo torácico, y evaluar su relación en el desarrollo de complicaciones. Metodología: Estudio de tipo descriptivo, prospectivo y analítico de una cohorte de pacientes con traumatismo torácico a los que se les hizo seguimiento durante un periodo de 30días. Se excluyeron pacientes con traumatismo craneoencefálico moderado a severo, fracturas de huesos largos, traumatismo abdominal, y pacientes que requirieron ventilación mecánica. Resultados: Un total 376 pacientes cumplieron criterios de inclusión, y de ellos 220 eran varones (58,5%). Las causas más frecuentes de traumatismo fueron las caídas (218 casos; 57,9%) y los accidentes de tráfico (57 casos; 15,1%). El tipo de traumatismo más frecuente fue la contusión costal (248 casos; 65,9%) y la fractura de un arco costal (61casos; 16,2%). Se observaron complicaciones en 43pacientes (11,4%), principalmente por hemotórax (13casos), neumotórax (9casos), neumonía (6casos) e insuficiencia renal aguda (4casos). De estos pacientes, 4fallecieron por neumonía y hemotórax. Treinta y tres pacientes (8,7%) fueron ingresados y 10 (2,6%) requirieron reingreso hospitalario. El riesgo de complicaciones aumenta significativamente en pacientes con más de 2 fracturas costales, en mayores de 85 años y en presencia de algunas comorbilidades como la EPOC y patologías que requieren anticoagulación. El riesgo de reingreso es mayor en pacientes con más de 60 años. Conclusiones: Los pacientes con traumatismo torácico que presentan algunas comorbilidades, son mayores de 85 años y tienen más de2 fracturas costales pueden presentar más complicaciones, y se deben considerar estos factores en su evaluación, manejo y seguimiento (AU)

Objective: To describe the clinical characteristics and risk factors of patients with chest trauma, and to evaluate their correlation with the development of complications. Methods: Descriptive, prospective and analytical study of a patient cohort with chest trauma who underwent follow-up for a period of 30days. Excluded from the study were those patients with moderate to severe traumatic brain injury, long-bone fractures, abdominal trauma and patients requiring mechanical ventilation. Results: A total of 376 patients met the inclusion criteria, 220 of whom were males (58.5%). The most frequent causes of trauma were falls (218 cases; 57.9%) and motor vehicle accidents (57 cases; 15.1%). The most frequent type of trauma was rib contusion (248 cases; 65.9%) and rib fractures (61 cases; 16.2%). Complications were observed in 43 patients (11.4%), mainly hemothorax (13 cases), pneumothorax (9 cases), pneumonia (6 cases) and acute renal failure (4 cases). Four patients died due to pneumonia and hemothorax. Thirty-three patients were hospitalized (8.7%) and 10 (2.6%) required later re-admittance. The risk for complications increased significantly in patients with more than 2 rib fractures, in those over the age of 85 and in the presence of certain comorbidities, such as COPD and pathologies requiring anticoagulation therapy. The risk for re-admittance is higher in patients over the age of 60. Conclusions: Patients with chest trauma who present certain comorbidities, are over the age of 85 and have more than 2 rib fractures may present more complications. These factors should be contemplated in the evaluation, management and follow-up of these subjects (AU)

Evolution and complications of chest trauma.

OBJECTIVE: To describe the clinical characteristics and risk factors of patients with chest trauma, and to evaluate their correlation with the development of complications. METHODS: Descriptive, prospective and analytical study of a patient cohort with chest trauma who underwent follow-up for a period of 30 days. Excluded from the study were those patients with moderate to severe traumatic brain injury, long-bone fractures, abdominal trauma and patients requiring mechanical ventilation. RESULTS: A total of 376 patients met the inclusion criteria, 220 of whom were males (58.5%). The most frequent causes of trauma were falls (218 cases; 57.9%) and motor vehicle accidents (57 cases; 15.1%). The most frequent type of trauma was rib contusion (248 cases; 65.9%) and rib fractures (61 cases; 16.2%). Complications were observed in 43 patients (11.4%), mainly hemothorax (13 cases), pneumothorax (9 cases), pneumonia (6 cases) and acute renal failure (4 cases). Four patients died due to pneumonia and hemothorax. Thirty-three patients were hospitalized (8.7%) and 10 (2.6%) required later re-admittance. The risk for complications increased significantly in patients with more than 2 rib fractures, in those over the age of 85 and in the presence of certain comorbidities, such as COPD and pathologies requiring anticoagulation therapy. The risk for re-admittance is higher in patients over the age of 60. CONCLUSIONS: Patients with chest trauma who present certain comorbidities, are over the age of 85 and have more than 2 rib fractures may present more complications. These factors should be contemplated in the evaluation, management and follow-up of these subjects.