title: [Thoracic surgery for non-small cell lung cancer. Cost-benefit of its management in specialized intermediate care].
abstract: In 1989, we reorganized acute and rehabilitation cares for patients operated for non small cell lung cancer (NSCLC) in order to decrease costs by setting up a specialised intermediate care unit (SICU). This report deals with the postoperative complications and the total cost of these cares (SICU, acute and rehabilitation cares) as well as their cost/benefit. From 1990 to 1994, we performed 95 thoracotomies, 7 exploratory and 88 with lung resection (24 pneumonectomies, 8 bilobectomies, 48 lobectomies and 8 segmentectomies or wedge resections). The postoperative staging was I in 52, II in 17, III a in 15, S III b in 2, IV in 2. Patients 30-days postoperative mortality was 2/95 (2.1%). We had in 11 patients respiratory complications (12%; 3 bronchopleural fistulas, 3 pneumonias, 3 pneumothorax > 7 days, 1 empyema, 1 chronic hypoxemia), in 15 patients cardiac arrhythmias which were easily controlled by medication and in 2 general complications (1 hemiplegia, 1 transitory stupor state). The total duration of hospital stay, including SICU, acute and rehabilitative cares, was 32 +/- 10 (3-70) days with a mean total cost of 14,722 Sfr. per case. In conclusion, surgery for NSCLC can be safely performed in intermediate cares without intensive care unit at low costs and with a low morbidity and mortality provided they are staffed by a specialised and well trained team.
authors.affiliation: Centre Valaisan de Pneumologie, Montana.
authors.forename: J M
authors.initials: JM
authors.lastname: Tschopp
authors.forename: M
authors.initials: M
authors.lastname: Brutsche
authors.forename: J G
authors.initials: JG
authors.lastname: Frey
authors.forename: B
authors.initials: B
authors.lastname: Tatti
authors.forename: E
authors.initials: E
authors.lastname: Aymon
authors.forename: A
authors.initials: A
authors.lastname: Spiliopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000534:rehabilitation / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007380:Intermediate Care Facilities / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008175:Lung Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D013903:Thoracic Surgery / Q000191:economics*
vernacular_title: Chirurgie thoracique pour cancer du poumon non à petites cellules. Coût-bénéfice d'une prise en charge en soins intermédiaires spécialisés.