title: Feasibility and results of a fast-track protocol in thoracic surgery.
abstract: BACKGROUND
  A rehabilitation program, a multimodal strategy favoring rapid postoperative return to autonomy, has rarely been undertaken after thoracic surgery compared to colectomy. The primary outcome of this fast-track program was the length of postoperative stay. Secondary outcomes concerned the feasibility of this strategy, the incidence of postoperative complications and 3-month postoperative mortality.
  
  
  METHODS
  Patients were included in this prospective single-center observational study if they were scheduled for lung resection (lobectomy or wedge resection) performed by posterolateral thoracotomy. The rehabilitation program, coordinated by a referent nurse, included a list of actions to be done, especially early feeding and ambulation, multimodal analgesia including epidural analgesia, early removal of chest tube.
  
  
  RESULTS
  One hundred and two patients were included in total with two exclusions (failure of epidural analgesia). The postoperative hospital stay was 8 (7-10) days (median [25-75th percentiles]); this duration was similar to that of the historical cohort which was 9 [7-13] days (P=0.06). Most actions were conducted with a high level of acceptance except for the insertion of a single chest tube (19%) and its removal later than expected in the program. Only 50% of patients left hospital shortly after exit criteria were met suggesting failure in the organization. Patients' satisfaction rate reached 77% and no postoperative death was reported during the follow-up period.
  
  
  CONCLUSIONS
  A program for early rehabilitation is feasible after thoracotomy. Chest drainage and organization to optimize the length of stay are crucial points.
authors.affiliation: Department of Anesthesiology, Foch Hospital, France and the University of Versailles Saint Quentin in Yvelines, France - m.fischler@hopital-foch.org.
authors.forename: Virginie
authors.initials: V
authors.lastname: Dumans-Nizard
authors.forename: Jeff
authors.initials: J
authors.lastname: Guezennec
authors.forename: François
authors.initials: F
authors.lastname: Parquin
authors.forename: Philippe
authors.initials: P
authors.lastname: Puyo
authors.forename: Edouard
authors.initials: E
authors.lastname: Sage
authors.forename: Rachida
authors.initials: R
authors.lastname: Abdat
authors.forename: Virginie
authors.initials: V
authors.lastname: Vaillant
authors.forename: Alain
authors.initials: A
authors.lastname: Chapelier
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dreyfus
authors.forename: Marc
authors.initials: M
authors.lastname: Fischler
authors.forename: Morgan
authors.initials: M
authors.lastname: LE Guen
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome