Surgical management of pneumothorax: significance of effective admission or communication strategies between the district general hospitals and specialized unit

Abstract

A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

“…Such patients often require thorax drainage over a longer period with complex drainage management and possibly an operation and thus involvement of a thoracic surgeon [105]. It is also recommended that thorax drainage management be performed by nursing staff with the necessary expertise.…”

“…Interdisciplinary pneumological/thoracic-surgical assessment of a patient with SSP is to be recommended, both initially and in cases of inadequate re-expansion of DOI: 10.1159/000490179 a pneumothorax or persistent air leakage over 48 h. The treatment of SSP can be complex and should be conducted in facilities where specialized medical and nursing knowledge is available [105]. A pneumological assessment of the underlying or newly-diagnosed lung disease is required.…”

Management of Spontaneous Pneumothorax and Postinterventional Pneumothorax: German S3-Guideline

“…und die Patienten haben häufiger und gravierendere Symptome[7], weshalb die Ablaufdiagramm zum SSP (DD: Differenzialdiagnose; TD: Thoraxdrainage).Sowohl initial als auch bei mangelnder Reexpansion eines Pneumothorax oder einer persistierenden Luftleckage über 48 Stunden ist die Beurteilung eines Patienten mit SSP interdisziplinär pneumologisch/thoraxchirurgisch empfehlenswert. Die Behandlung des SSP kann komplex sein und soll dann dort stattfinden, wo spezialisierte ärztliche und pflegerische Kenntnisse vorhanden sind[105]. Eine pneumologische Beurteilung der zugrunde liegenden oder neu diagnostizierten Lungenerkrankung ist erforderlich.…”