National practice variation in pneumonectomy perioperative care among Canadian thoracic surgeons

OBJECTIVES: Our objective was to assess perioperative pneumonectomy practices among Canadian thoracic surgeons as part of a quality-improvement initiative to determine practice variability and identify areas for study/improvement. METHODS: After several rounds of survey development and piloting, a 29-item survey was distributed using the Dillman method to all practicing members of the Canadian Association of Thoracic Surgeons. RESULTS: The response rate was 87% (62 of 71). Median number of pneumonectomies performed annually was 3.5 (interquartile range 2.75-5.00). Routine preoperative workup was variable, but the most consistently reported tests were diffusing capacity of the lungs for carbon monoxide (87%, n = 54) and spirometry (85%, n = 53). Reported routine use of epidurals (84%, n = 52) was more prevalent than paravertebral blocks (18%, n = 11). Many (69%, n = 43) reported intraoperative restriction <2 l. Postoperatively, 84% (n = 52) reported daily fluid restriction <2 l. Regarding intraoperative protective ventilation strategies, respondents appeared more focused on minimizing peak airway pressures (55%, n = 34) rather than tidal volumes (18%, n = 11). Twenty-four percent (n = 15) reported using intraoperative steroids in attempts to decrease postoperative complications. Thirty-two percent (n = 20) do not routinely insert chest tubes, whereas the most common practice (44%, n = 27) was to insert chest tubes attached to conventional drainage systems without suction. Eighty-two percent (n = 52) reported willingness to participate in multicentre studies regarding perioperative pneumonectomy practices. CONCLUSIONS: Our findings suggest significant variability in reported preoperative, intraoperative and postoperative care practices for pneumonectomy across Canada. This survey has a high response rate, representing the Canadian experience, and highlights several areas for study and quality-improvement initiatives. Many respondents report willingness to participate in multicentre initiatives.