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a Department of Thoracic Surgery, Cedars Sinai Medical Center, Los Angeles, California
b Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor, Michigan
Accepted for publication May 22, 2007.
* Address correspondence to Dr McKenna, 8635 West Third, Suite 975W, Los Angeles, CA 90048 (Email: mckennar{at}cshs.org).
Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.
Background: In the era of cost containment, a fast-tracking protocol was developed to reduce cost and shorten the length of stay after a lobectomy. The purpose of our study was to see whether a fast-tracking protocol provided a short length of stay without compromising morbidity and mortality or leading to readmission to the hospital.
Methods: The protocol was to perform lobectomies by means of video-assisted thoracoscopic surgery with no routine postoperative laboratory work or chest roentgenograms. The chest tubes were discontinued once the output was less than 300 mL in a 24-hour period and there was no air leak present. If the chest tube output was low, but there was an air leak, the patient was discharged home with a Heimlich valve.
Results: Two hundred eighty-two consecutive video-assisted thoracoscopic surgery lobectomies were performed by a single surgeon during 18 months in 158 women (56%) and 124 men (44%), with a mean age of 71.2 years. Following this protocol, the mean length of stay was 3.26 days, and the median was 3 days. Seven of 282 patients (2.5%) were discharged with a Heimlich valve. There was 1 mortality. There were no complications in 251 patients (89%). Two patients were readmitted to the hospital. No chest tubes were reinserted.
Conclusions: Using a fast-tracking protocol, video-assisted thoracoscopic surgery lobectomy with anatomic dissection can be performed with minimal complication, a short postoperative length of stay, and reduced costs.
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