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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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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:
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
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author 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
author_facet 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
author_sort dos Santos, Laura Lucato
collection PubMed
description 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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spelling pubmed-105525582023-10-06 Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis 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 Braz J Cardiovasc Surg Review Article 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. Sociedade Brasileira de Cirurgia Cardiovascular 2023-09-19 /pmc/articles/PMC10552558/ /pubmed/37801640 http://dx.doi.org/10.21470/1678-9741-2022-0326 Text en https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
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
Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis
title Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis
title_full Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis
title_fullStr Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis
title_full_unstemmed Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis
title_short Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis
title_sort outcomes of chylothorax nonoperative management after cardiothoracic surgery: a systematic review and meta-analysis
topic Review Article
url 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
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