1. The rate of catheterization with epidural is 27.5%. However, the rate of indwelling catheter >48
hours is 10%, consistent with previous studies.5 80% of patients have their chest tubes removed
within 48 hours, much higher than previous studies (12%) and even recommended new digital
protocols (51%).6 The average duration of epidural is 2.00±1.32 days, much lower than previous
studies (5.7±2.2 days) and even research focused on VAT (video-assited, minimally invasive)
lobectomy (4.6±1.7 days).7
Epidural and chest tube lengths do not predict whether the patient requires a Folly (logistic
regression, p=0.7918, confidence 95%) (Figure 6). However, the duration of epidural has a
significant correlation with the duration of chest tube (ANOVA, p = 7.27x10-6).
Introduction
Methods
Results
Conclusions
Lobectomy is a procedure that involves the
surgical excision of a lobe of the lung. This is
often performed on patients with non-small cell
cancer and a lesion size greater than 2 cm.1
Research has shown that the length of the
epidural, chest tube drainage, and Folly
catheterization (urinary catheter) could all be
used to predict the outcome of a patient in a
variety of procedures.2,3,4 However, such studies
References
1. El-Sherif, Amgad, et al. "Outcomes of sublobar resection versus lobectomy for stage I non–small cell lung
cancer: a 13-year analysis." The Annals of thoracic surgery 82.2 (2006): 408-416.
2. Noppen, Marc, et al. "Manual aspiration versus chest tube drainage in first epsisodes of primary spontaneous
pneumothorax: a multicenter, prospective, randomized pilot study." American Journal of Respiratory and Critical Care
Medicine 165.9 (2002): 1240-1244.
3. Zaouter, Cedrick, Pepa Kaneva, and Franco Carli. s"Less urinary trasct infection by earlier removal of bladder catheter in
surgical patients receiving thoracic epidural analgesia." Regional anesthesia and pain medicinse 34.6 (2009): 542-548.
4. Raveglia, Federico, et al. "Analgesia in patients undergoing thoracotomy: epidural versus paravertebral technique. A
randomized, double-blind, prospective study." The Journal of thoracic and cardiovascular surgery 147.1 (2014): 469-474.
5. Ladak, Salima SJ, et al. "Incidence of urinary retention in patients with thoracic patient-controlled epidural analgesia
(TPCEA) undergoing thoracotomy." Pain Management Nursing 10.2 (2009): 94-98.
6. Brunelli, Alessandro, et al. "Evaluation of a new chest tube removal protocol using digital air leak monitoring after
lobectomy: a prospective randomised trial." European Journal of Cardio-Thoracic Surgery 37.1 (2010): 56-60.
7. Nagahiro, Itaru, et al. "Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison
of VATS and conventional procedure." The Annals of Thoracic Surgery 72.2 (2001): 362-365.
A data base consisting of 41 lobectomy patients were used. All patients received lobectomy
from January 2014 to January 2017, and the procedure is performed by the same provider. The
rate of urinary retention was reflected through Folly catheterization, as the length of lobectomy
does not indicate catheterization. The length and volume of chest tube drainage is recorded
through SCM Allscripts Gateway. The procedure notes were collected through EHR and Dr.
Peverada’s surgical database. X-ray, CT, and PET images were studied through PACS. Various
statistical methods, including logistic regression, ANOVA, etc. were used to investigate the
correlation of different parameters.
Figure 1. The patient’s left upper lobe adenocarcinoma can
be seen on this pre-op CT scan. The lesion is 5.5 cm,
unifocal, an indicator of lobectomy.
Figure 2. A pre-op PET (positron emission tomography) scan shows
the active tumor site lit up in the image above. It labels the tissues
with intense glucose uptake, which includes cancer.
Figure 3. A post-op CT scan shows the excision of the left
upper lobe. The patient is now tumor-free.
Figure 4. A post-op PET scan shows that the tumor site no longer
lights up.
The rate of Folly catheterization of lobectomy patients under epidural is found to be consistent with other procedures. This low urinary retention rate
indicates that epidural is an effective pain control method with minimal side effects. The lobectomy procedure performed by MaineGeneral lead by
Dr. Peverada is found to have an epidural and chest tube duration lower than the national average, and open incision could have better outcomes
than VAT under certain settings. A larger sample size is required to investigate the relationship between cancer type and patient outcomes.
Prediction of Lobectomy Patient Outcome Using Epidural Duration,
Chest Tube Drainage, Cancer type, and Folly Catheterization
Stacey Hou, Philip T. Peverada, MD
The data on n=41 patients were analyzed. 55% of patients were found with adenocarcinoma and 12.5% of patients with squamous cell carcinoma.
The most common lobe of resected is the right lower lobe, comprising 35% of total lobectomies. The left lower lobe resection (32.5%) is the second
most common procedure (Figure 5).
Based on limited data (n=8), cancer type is not an indicator of length of survival (Figure 9), but could be an indicator of chest tube drainage (n=41)
(Figure 7). Also shown in figure 7 and 8, epidural length and Folly duration do not seem to correlate with cancer type or lobe location.
have not been done on lobectomy. In this project, the correlations of the rate of epidural usage,
urinary retention, cancer type, and lobe location are investigated and patient outcomes are
predicted post lobectomy.
Acknowledgements
I would like to thank Dr. Peverada,
Dr. Bolduc, and Dr. Blank for
providing a great shadowing
experience and leading my project. I
would also like to thank Vicki,
Melissa, John, Carl, Jan and other
doctors, nurses, PAs, and
anesthesiologists working at
MaineGeneral OR for their great
support on the project and on
shadowing. I would also like to
thank Dr. Diaz, Dr. Berkner, and Cate
Asshton for organizing this great
program and connecting me to
resources. This project would not
have existed without any of you.
Figure 5 Figure 6
Figure 7 Figure 8
-1
0
1
2
3
4
5
6
7
-0.5 0 0.5 1 1.5 2 2.5 3 3.5
Epidural/Days
The Correlation of Usage of Epidural, Chest Tube, and Folly
Chest Tube Folly Log. (Folly) Poly. (Folly)
Figure 9