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Short-term perioperative treatment with ambroxol reduces pulmonary complications and hospital costs after pulmonary lobectomy: a randomized trial

Department of Thoracic Surgery, Umberto I Regional Hospital Ancona, Italy

Received 9 July 2008; received in revised form 28 October 2008; accepted 10 November 2008.

^_* Corresponding author. Address: Via S. Vincenzo 5/f, Polverigi 60020, Italy. Tel.: +39 0715964439; fax: +39 0715964433. (Email: majedit{at}yahoo.com).

Objective: To assess in a randomized clinical trial the influence of perioperative short-term ambroxol administration on postoperative complications, hospital stay and costs after pulmonary lobectomy for lung cancer. Methods: One hundred and forty consecutive patients undergoing lobectomy for lung cancer (April 2006–November 2007) were randomized in two groups. Group A (70 patients): ambroxol was administered by intravenous infusion in the context of the usual therapy on the day of operation and on the first 3 postoperative days (1000 mg/day). Group B (70 patients): fluid therapy only without ambroxol. Groups were compared in terms of occurrence of postoperative complications, length of stay and costs. Results: There were no dropouts from either group and no complications related to treatment. The two groups were well matched for perioperative and operative variables. Compared to group B, group A (ambroxol) had a reduction of postoperative pulmonary complications (4 vs 13, 6% vs 19%, p = 0.02), and unplanned ICU admission/readmission (1 vs 6, 1.4% vs 8.6%, p = 0.1) rates. Moreover, the postoperative stay and costs were reduced by 2.5 days (5.6 vs 8.1, p = 0.02) and 2765 Euro (2499 Euro vs 5264 Euro, p = 0.04), respectively. Conclusions: Short-term perioperative treatment with ambroxol improved early outcome after lobectomy and may be used to implement fast-tracking policies and cut postoperative costs. Nevertheless, other independent trials are needed to verify the effect of this treatment in different settings.

Key Words: Pulmonary lobectomy • Non-small cell lung cancer • Postoperative complications • Ambroxol