Randomized Clinical Trial of the Effectiveness of Thoracotomy Wound Management for the Prevention of Infectious Complications and Additional Anesthesia

Relevance Thoracotomy is a widely used method of access to the chest, however, its use is associated with a high risk of surgical site infections. According to the World Health Organization, infectious complications are the most common problem in surgical practice. They can significantly worsen the patients’ condition after surgery, increase the length of their hospital stay and create significant financial difficulties for the healthcare system. The proposed method of thoracotomy wound management can significantly reduce the incidence of unwanted postoperative infections, which, in turn, will reduce the burden on the healthcare system.

The aim of the study To evaluate the effectiveness of the proposed method of thoracotomy wound management after anatomical lung resections, in order to prevent infection after surgery and additional anesthesia by comparative analysis with the control group.

Material and methods The study was conducted on the basis of the Department of Thoracic Oncology Surgery of the Regional Clinical Oncological Dispensary, Ulyanovsk, Russia. The analysis included 63 patients at high and medium risk of developing surgical site infections (SSIs), who were divided into two groups of 32 and 31 people. Group 1 (32 patients) was the control group, group 2 (31 patients) were patients who underwent the developed method of complex thoracotomy wound management. All the patients underwent elective thoracotomy for anatomical lung resection (lobectomy or segmentectomy) in the period from 06/15/2023 to 11/18/2024. The characteristics of the studied patients were evaluated according to a single developed protocol.

Results The incidence of SSIs in the control group was 28.1% (9/32), while in the group where preventive management of the postoperative wound was performed, this indicator was 6.5% (2/31), p=0.043.

When performing a one-factor statistical analysis of the postoperative parameters of the studied groups of patients, statistically significant indicators were determined: the pain visual analog scale on day 1 (p=0.006), neutrophil-lymphocyte ratio on day 1 (p=0.003), platelet-lymphocyte ratio on day 1 (p=0.039); cortisol level on day 1 day (p=0.004) and day 5 (p=0.017); forced expiratory volume in 1 second and vital capacity for 1 day after surgery (p=0.038) and (p=0.027), respectively, forced vital capacity for 1 day after surgery (p=0.033).

Conclusions The application of the developed technique for the management of postoperative thoracotomy wounds reduces the development of infectious complications in patients with moderate and high risk of surgical site infections, and also provides adequate anesthesia.

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