Fast-tracking after video-assisted thoracoscopic surgery lobectomy, segmentectomy, and pneumonectomy.
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.
McKenna
Robert J
RJ
Department of Thoracic Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA. mckennar@cshs.org
Mahtabifard
Ali
A
Pickens
Allan
A
Kusuanco
Donato
D
Fuller
Clark Beeman
CB
D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011013:Pneumonectomy / Q000191:economics / Q000379:methods* / Q000401:mortality; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics / Q000379:methods* / Q000401:mortality; D013908:Thoracotomy