{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:31:54Z","timestamp":1747182714851,"version":"3.40.5"},"reference-count":20,"publisher":"Wiley","issue":"27","license":[{"start":{"date-parts":[[2023,8,13]],"date-time":"2023-08-13T00:00:00Z","timestamp":1691884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Thoracic Cancer"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pleurectomy and decortication (PD) in malignant pleural mesothelioma has a high morbidity mostly associated with aspiration pneumonia (PNA), deep vein thrombosis (DVT), and foreign catheter sepsis. We instituted four strategies to reduce these complications and report our experience.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective review of patients who underwent PD at the University of Pennsylvania between 2015 and 2022. Our patients underwent standard of care PD in addition to tracheostomy and gastrostomy\/jejunostomy tube with therapeutic anticoagulation (AC) leading up to surgery. Measured outcomes were postoperative PNA, DVT, and sepsis. The predicted risk of those same outcomes had patients not undergone the interventions was calculated based on the American College of Surgeons (ACS) surgical risk calculator (SRC). A McNemar's test was used to determine whether the risk of having PNA, DVT and sepsis differed between the two subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010five patients were included in the study. The mean age was 70\u2009years (SD 6.2) with a mean of 21 (SD 19) pack\u2010years of smoking. PNA, DVT, and catheter\u2010related sepsis occurred in 12, four, and seven patients, respectively. Upon using the ACS SRC prediction model of the nonintervention group, PNA, DVT and catheter related sepsis was predicted to occur in 24 (paired data OR 5, 95% CI: 1.4\u201317.2; McNemar's test <jats:italic>p<\/jats:italic>\u2009=\u20090.008), 14 (paired data OR 3.5, 95% CI: 1.15\u201310.6; McNemar's test <jats:italic>p<\/jats:italic>\u2009=\u20090.03), and 17 (paired OR 3, 95% CI: 1.09\u20138.3; McNemar's test <jats:italic>p<\/jats:italic>\u2009=\u20090.04) patients, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Patients undergoing tracheostomy creation, therapeutic AC at the time of diagnosis, and gastrostomy tube placement had a reduced risk of aspiration PNA, DVT, and catheter sepsis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1759-7714.15067","type":"journal-article","created":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T03:50:15Z","timestamp":1691985015000},"page":"2770-2776","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Strategies to reduce morbidity following pleurectomy and decortication for malignant pleural mesothelioma"],"prefix":"10.1111","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6397-5644","authenticated-orcid":false,"given":"Patrick","family":"Bou\u2010Samra","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7343-6874","authenticated-orcid":false,"given":"Austin","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Zhang","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feredun","family":"Azari","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei\u2010Ting","family":"Hwang","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Department of Biostatistics, Epidemiology, and Informatics (DBEI) University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Singhal","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania 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