Early air transport after thoracic surgery might be safe: A retrospective observational study in the French Caribbean

Chloé Lafouasse; Moustapha Agossou; Kais Ben Hassen; Rémi Nevière; Bruno Sanchez; Nicolas Venissac

doi:10.1016/j.xjon.2021.12.003

Early air transport after thoracic surgery might be safe: A retrospective observational study in the French Caribbean

JTCVS Open. 2021 Dec 16:9:333-339. doi: 10.1016/j.xjon.2021.12.003. eCollection 2022 Mar.

Authors

Chloé Lafouasse¹, Moustapha Agossou², Kais Ben Hassen¹, Rémi Nevière², Bruno Sanchez¹, Nicolas Venissac¹

Affiliations

¹ Department of Thoracic & Cardiovascular Surgery, University Hospital of Martinique, Fort-de-France, Martinique, France.
² Divisions of Pneumology and Physiology, Departments of Thoracic and Cardiovascular Surgery and Medicine, University Hospital of Martinique, Fort-de-France, Martinique, France.

Abstract

Objective: The objective of this study was to determine the incidence of early air transport (EAT) morbidity after transpleural surgery. We compared our cohort with our patients not requiring air transport.

Methods: This was a retrospective observational study, in the Thoracic and Cardiovascular Surgery Department of the University Hospital of Martinique over 40 months. We included all of the files (national and local database, and systematic postoperative consultation) of patients operated on for thoracic surgery or distinguished transpleural surgical intervention, whatever their geographical origin. Patients from another French department benefited from EAT. The complications were classified according to Clavien-Dindo before or after the EAT. Diagnostic criteria were chest pain, dyspnea, and abnormal chest radiograph. Continuous variables are presented as mean, median, and SDs. Discrete variables are presented as n (%).

Results: Of 491 patients operated on, 315 were transpleural surgeries, and 99 patients benefited from EAT. There were 55% resections, a percent predicted of forced expiratory volume in 1 second, and an average preoperative Tiffeneau ratio of respectively, 86% and 78. One complication was found: a pneumothorax in an emphysematous patient, 15 days after the flight, who had an index of prolonged air leak >10. The mean time between surgery and flight was 7.2 days (σ = 4.5), and 3.3 days (σ = 2.9) between removal of the last drain and flight. The morbidity of EAT after transpleural surgery was 1%. The 2 cohorts of "EAT" and "Locals" patients were statistically comparable, particularly in morbidity.

Conclusions: EAT appears to be safe after transpleural surgery, following usual criteria for hospital discharge. It would be interesting to study, on a larger scale, the effect of IPAL as an independent risk factor (in case of high IPAL > 10) as well as pathologies that modify transpleural pressures restrictive ventilatory defect.

Keywords: AT, air transport; EAT, early air transport; IPAL, index of prolonged air leak; RVD, restrictive ventilatory defect; air travel; early air travel; flying; pneumothorax; safety; thoracic surgery; transpleural surgery.