Fast-tracking pulmonary resections

摘要: Abstract Objective: We streamlined our care after pulmonary resection for quality and cost-effectiveness. Methods: A single surgeon performed 500 consecutive resections through a thoracotomy over 2¾-year period in university setting. Patients were extubated the operating room sent directly to their hospital room. Chest tubes placed water seal removed on postoperative day 2 if there was no air leak drainage less then 400 mL/d. Epidural catheters used by 2. The plan each discharge 3 or 4 reviewed with patients families daily during rounds. patient went home last chest tube removed. Persistent leaks treated Heimlich valves. Results: There (338 men), median age of 58 years (range, 3-87 years). Of these patients, 293 had pre-existing conditions. Seventy-three (15%) been denied operations at least one other surgeon. Four hundred nineteen (84%) successful placement functioning preoperative epidural catheter. Pneumonectomy 32 (6%) segmentectomy 16 (3%) lobectomy, sleeve and/or bilobectomy 194 (39%) patients. Nonanatomic metastasectomy. This included wedge 161 (32%) multiple 97 (19%) total 482 (96%) room, 380 (76%) remaining 120 intensive unit 1 1-41 days). Complications occurred 107 (21%) operative mortality 2.0%. Median 2-119 327 (65%) left sooner. By survey, 97% excellent good satisfaction discharge, 91% extremely happy satisfied 2-week follow-up contact. Conclusions: Most who undergo elective can be immediately operation, go avoid unit, discharged 4, have minimal morbidity high both Techniques that seem accomplish this include following: use seal, removal 2, early management, treatment persistent valves, reinforcement planned events day, as well date families. J Thorac Cardiovasc Surg 2001;122:318-24