Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis

INTRODUCTION: Chylothorax after thoracic surgery is a severe complication with high morbidity and mortality rate of 0.10 (95% confidence interval [CI] 0.06 – 0.02). There is no agreement on whether nonoperative treatment or early reoperation should be the initial intervention. This systematic review...

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Detalles Bibliográficos
Autores principales: dos Santos, Laura Lucato, dos Santos, Clara Lucato, Hu, Natasha Kasakevic Tsan, Datrino, Leticia Nogueira, Tavares, Guilherme, Tristão, Luca Schiliró, Orlandini, Marina Feliciano, Serafim, Maria Carolina Andrade, Tustumi, Francisco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Cirurgia Cardiovascular 2023
Materias:
Review Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10552558/
https://www.ncbi.nlm.nih.gov/pubmed/37801640
http://dx.doi.org/10.21470/1678-9741-2022-0326
Descripción
Sumario:INTRODUCTION: Chylothorax after thoracic surgery is a severe complication with high morbidity and mortality rate of 0.10 (95% confidence interval [CI] 0.06 – 0.02). There is no agreement on whether nonoperative treatment or early reoperation should be the initial intervention. This systematic review and meta-analysis aimed to evaluate the outcomes of the conservative approach to treat chyle leakage after cardiothoracic surgeries. METHODS: A systematic review was conducted in PubMed®, Embase, Cochrane Library Central, and LILACS (Biblioteca Virtual em Saúde) databases; a manual search of references was also done. The inclusion criteria were patients who underwent cardiothoracic surgery, patients who received any nonoperative treatment (e.g., total parenteral nutrition, low-fat diet, medium chain triglycerides), and studies that evaluated chylothorax resolution, length of hospital stay, postoperative complications, infection, morbidity, and mortality. CENTRAL MESSAGE: Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates. RESULTS: Twenty-two articles were selected. Pulmonary complications, infections, and arrhythmia were the most common complications after surgical procedures. The incidence of chylothorax in cardiothoracic surgery was 1.8% (95% CI 1.7 – 2%). The mean time of maintenance of the chest tube was 16.08 days (95% CI 12.54 – 19.63), and the length of hospital stay was 23.74 days (95% CI 16.08 – 31.42) in patients with chylothorax receiving nonoperative treatment. Among patients that received conservative treatment, the morbidity event was 0.40 (95% CI 0.23 – 0.59), and reoperation rate was 0.37 (95% CI 0.27 – 0.49). Mortality rate was 0.10 (95% CI 0.06 – 0.02). CONCLUSION: Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates.

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