Does minimally invasive thoracic surgery warrant fast tracking of thoracic surgical patients?

摘要

Fast-tracking protocols or postoperative care computerized algorithms have been shown to reduce hospital LOS and reduce costs for patients. who undergo both open and VATS procedures The ability to fast-track is not governed by the type of procedure (closed versus open), but rather by patient characteristics and the mindset of the operating surgeon and the postoperative care team. While use of protocols enhance the ability of many physicians to fast-track many different types of patients, it is a mistake to force these protocols on all patients because, if not modified, they can lead to increased complications, readmissions, and low patient and family satisfaction. By carefully analyzing surgical results using accurate prospective databases, the types of patients who fail fast-tracking and the reasons they fail can be identified. Specific changes to the postoperative algorithms can be implemented and these alterations can lead to improved outcomes. For example, we have shown that by using pain pumps instead of epidurals in elderly patients we can improve outcomes and still fast-track octogenarians with minimal morbidity and high patient satisfaction. We have also shown that the use of increased physical therapy and respiratory treatments (important parts of the care of all patients after pulmonary resection, but a limited resource in most hospitals) may also lead to improved surgical results for those with low FEV1% and DLCO%. Although fast-tracking protocols cannot be applied to all, the vast majority of patients who undergo elective pulmonary resection, even those at high risk, can undergo safe, efficient and cost-saving care by way of preset postoperative algorithms after VATS or thoracotomy procedures. When the typical daily events are communicated each morning and the planned date of discharge is reinforced with the patient and family before surgery and each day in the hospital on rounds, most patients can be safely fast-tracked with high satisfaction and outstanding results.