Parameters affecting pleural drainage and a management strategy after
Background: Prolonged pleural drainage after the Fontan procedure is a
common complication. Various protocols have been described, but there is
no definitive consensus for the treatment of this complication.
Materials and Methods: Our primary aim was to determine the effect of
the protocol on the duration of drainage and hospital stay. Our
secondary aim was to determine parameters affecting prolonged drainage
after the Fontan procedure. Ninety two consecutive patients who
underwent the Fontan operation retrospectively analyzed. A
protocol-based postoperative management was adopted at July 2018.
Patients operated before the protocol were defined as Group 1(n=48), and
patients operated after the protocol were defined as Group 2(n=44).
Results: The mean age was 5(IQR 4.0-6.9) years the mean body weight was
17.3 (IQR 15.1-21.8) kg.There were statistically significant differences
between groups in terms of total drainage, duration of pleural drainage,
prolonged drainage and, LOHS(p=0.05,p=0.04, p=0.04,p=0.04,respectively).
In the multivariate analysis, the application of the protocol was
observed to be the only factor for prolonged drainage (OR:2.46, 95% CI
Lower-Upper:1.03-5.86,p=0.04). Conclusion: Standardization and strict
application of the medical treatment within a specific protocol without
being affected by doctor, nurse or patient-based factors increases the
success. After the changes in our medical management strategy, along
with the decrease in total drainage and duration of pleural drainage,
LOHS was also reduced, of course together with a reduction in the cost.
Key Words: Fontan, pleural drainage, hospital stay, protocol