Most investigators in thoracic surgery perform research in single center setting whereby results are not widely supported and implementation fails. In the process of developing rosaceous research proposals for health care evaluation in a multicenter setting, principal investigators fall in repetitive attempts for collaboration with patient organizations and health technology assessment (HTA) experts, as well as for invariable support from national scientific societies. There is a need to bring constant unanimity and collaboration between the relevant parties within a definite research consortium that is anchored within the national scientific societies for effective, reliable and relevant research on prioritized topics in thoracic surgery.
A more definite partnership between patient organizations, NVvL and NVT, as well as HTA experts within a research consortium will improve the identification of relevant knowledge gaps and such a consortium will invariably lead to more efficient and patient-centered health care evaluation research.
Currently, we wish to create a research consortium and develop our first project focused on improving and optimizing perioperative care after pneumothorax. Primary spontaneous pneumothorax (PSP) is a common condition, with an incidence of 12.3 cases per 100.000 in young healthy males. After primary conservative treatment recurrence rates are high (approximately 30%). In case of recurrent PSP or persistent air leakage (= 5 days) after primary treatment, guidelines recommend surgical intervention. Guidelines however lack consensus regarding (peri)operative care, since the quality of the published literature is moderate to low which leads to variation in clinical management. We have sent an online case-based survey to all thoracic surgeons in the Netherlands performing surgical treatment for PSP (publication will follow), in order to investigate the variation in perioperative care of PSP in the Netherlands. This survey showed noticeable variation in drain and pain management. Approximately 40% of surgeons applied early drain removal whereas 60% complied to late drain removal (varying between 2-5 days). In addition, 80% of respondents used thoracic epidural analgesia (TEA) as preferred pain management, whereas only 20% used locoregional single-shot or systemic analgesia. As TEA is associated with patient immobilization, bladder dysfunction and hypotension, this may have impact on recovery and LOS. The decision on which approach to choose lays mostly in the hands of the responsible surgeon and anesthesiologist. Since drain and pain policy has a high impact on patient satisfaction, quality of recovery and LOS, we aim to investigate whether a strategy of early drain removal and the use of locoregional single-shot analgesia is more cost-effective than current standard care.