Optimal Fat-Modified Diet Duration for the Treatment of Postoperative Chylothorax in Children

Document Type

Article

Publication Date

7-2024

Publisher

Elsevier

Source Publication

The Annals of Thoracic Surgery

Source ISSN

0003-4975

Original Item ID

DOI: 10.1016/j.athoracsur.2023.05.021

Abstract

Background

Dietary modification is the mainstay of treatment for postoperative cyclothorax in children. However, optimal fat-modified diet (FMD) duration to prevent recurrence is unknown. Our aim was to determine the association between FMD duration and chylothorax recurrence.

Methods

Retrospective cohort study conducted across 6 pediatric cardiac intensive care units within the United States. Patients aged < 18 years who developed chylothorax within 30 days after cardiac surgery between January 2020 and April 2022 were included. Patients with a Fontan palliation, who died, or were lost to follow-up or within 30 days of resuming a regular diet were excluded. FMD duration was defined as the first day of a FMD when chest tube output was < 10 mL/kg/d without increasing until the resumption of a regular diet. Patients were classified into 3 groups (< 3 weeks, 3-5 weeks, >5 weeks) based on FMD duration.

Results

A total of 105 patients were included: < 3 weeks (n = 61) 3-5 weeks (n = 18), and >5 weeks (n = 26). Demographic, surgical, and hospitalization characteristics were not different across groups. In the >5 weeks group, chest tube duration was longer compared with the < 3 weeks and 3-5 weeks groups (median, 17.5 days [interquartile range, 9-31] vs 10 and 10.5 days; P = .04). There was no recurrence of chylothorax within 30 days once chylothorax was resolving regardless of FMD duration.

Conclusions

FMD duration was not associated with recurrence of chylothorax, suggesting that FMD duration can safely be shortened to at least < 3 weeks from time of resolving chylothorax.

Comments

The Annals of Thoracic Surgery, Vol. 118, No. 1 (July 2024): 181-187. DOI.

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