Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway.
BACKGROUND
Fast track programs, multimodal therapy strategies, have been introduced in many surgical fields to minimize postoperative morbidity and mortality. In terms of lung resections no randomized controlled trials exist to evaluate such patient care programs.


METHODS
In a prospective, randomized controlled pilot study a conservative and fast track treatment regimen in patients undergoing lung resections was compared. Main differences between the two groups consisted in preoperative fasting (6h vs 2h) and analgesia (patient controlled analgesia vs patient controlled epidural analgesia). Study endpoints were pulmonary complications (pneumonia, atelectasis, prolonged air leak), overall morbidity and mortality. Analysis was performed in an intention to treat.


RESULTS
Both study groups were similar in terms of age, sex, preoperative forced expiratory volume in one second (FEV(1)), American Society of Anesthesiologists score and operations performed. The rate of postoperative pulmonary complications was 35% in the conservative and 6.6% in the fast track group (p=0.009). A subgroup of patients with reduced preoperative FEV(1) (<75% of predicted value) experienced less pulmonary complications in the fast track group (55% vs 7%, p=0.023). Overall morbidity was not significantly different (46% vs 26%, p=0.172), mortality was comparable in both groups (4% vs 3%).


CONCLUSIONS
We evaluated an optimized patient care program for patients undergoing lung resections in a prospective randomized pilot study. Using this fast track clinical pathway the rate of pulmonary complications could be significantly decreased as compared to a conservative treatment regimen; our results support the implementation of an optimized perioperative treatment in lung surgery in order to reduce pulmonary complications after major lung surgery.
Muehling
Bernd M
BM
Department of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany. bernd.muehling@uniklinik-ulm.de <bernd.muehling@uniklinik-ulm.de>
Halter
Gisela L
GL
Schelzig
Hubert
H
Meierhenrich
Rainer
R
Steffen
Peter
P
Sunder-Plassmann
Ludger
L
Orend
Karl-Heinz
KH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature; D019091:Critical Pathways; D004812:Epidemiologic Methods; D005260:Female; D005541:Forced Expiratory Volume; D005858:Germany; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control; D012121:Respiration, Artificial