title: Obstacles for shortening hospitalization after video-assisted pulmonary resection for lung cancer.
abstract: BACKGROUND
  Video-assisted thoracic surgery for lung cancer facilitates early postoperative recovery when patients are treated by critical pathway management. Thus, we developed an original programmed regimen for postoperative management, evaluated the validity of this regimen, and analyzed clinical factors influencing postoperative recovery.
  
  
  METHODS
  Forty consecutive patients with suspicious lung cancer undergoing anatomic pulmonary resection with video-assisted thoracic surgery were enrolled in this prospective study. After surgery, all patients who underwent anatomic resection were managed using our programmed regimen; a patient was considered recovered when the regimen had been completed.
  
  
  RESULTS
  On final pathologic examination, 37 cases were determined to have lung cancer and underwent anatomic resection. The mean number of resected segments was 3.6. There were no complications caused by postoperative management. The mean day of postoperative recovery was 3.7 days and median, 3 days. Significant preoperative factors related to recovery were age, breathlessness, performance status, radiologic emphysema, partial pressure of arterial oxygen, and predictive postoperative forced expiratory volume in 1 second. The overall number of these risk factors was specifically related to postoperative recovery (p < 0.01): the rate of recovery on postoperative day 3 was 100% in patients with no risk, 68% in those with one to three risks, and 22% in those with four to six risks.
  
  
  CONCLUSIONS
  Our original regimen is useful as a critical pathway for the management of lung cancer patients undergoing video-assisted thoracic surgery. Furthermore, we created specific criteria to identify risk factors related to postoperative recovery that may be useful in planning hospitalization for patients undergoing video-assisted thoracic surgery.
authors.affiliation: First Department of Surgery, Yamaguchi University School of Medicine, Ube Yamaguchi, Japan. kaueda@po.cc.yamaguchi-u.ac.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ueda
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kaneda
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakano
authors.forename: Toshiki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Tao Sheng
authors.initials: TS
authors.lastname: Li
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Hamano
mesh_terms: D000368:Aged; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011182:Postoperative Care; D011183:Postoperative Complications; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted