PMID- 32735430
OWN - NLM
STAT- MEDLINE
DCOM- 20201119
LR  - 20201119
IS  - 1488-2310 (Electronic)
IS  - 0008-428X (Print)
IS  - 0008-428X (Linking)
VI  - 63
IP  - 4
DP  - 2020 Jul 31
TI  - Feasibility analysis for the development of a video-assisted thoracoscopic (VATS) 
      lobectomy 23-hour recovery pathway.
PG  - E349-E358
LID - 10.1503/cjs.002219 [doi]
AB  - BACKGROUND: Video-assisted thoracoscopic (VATS) lobectomy has been demonstrated 
      to offer several benefits over open surgery. The purpose of this study was to 
      assess the feasibility and safety of an ultra-fast-track 23-hour recovery pathway 
      for VATS lobectomy. METHODS: A prospectively maintained institutional database 
      was queried for patients who underwent VATS lobectomy from 2006 to 2016 at the 
      McGill University Health Centre in Montreal, Quebec, and data were supplemented 
      with focused chart review. Patients discharged with a length of stay (LOS) of 23 
      hours or less were compared with those with an LOS of 2 days or more. Logistic 
      regression was performed to identify predictors of LOS of 23 hours or less. 
      RESULTS: Two hundred and five patients were included in the study. Perioperative 
      30-day mortality for our cohort was 0% and the major complication rate was 8.3%. 
      The median LOS was 3 days (interquartile range [IQR] 2-4 d). Thirty-four patients 
      were discharged within 23 hours and none of them required readmission; 171 
      patients were discharged on postoperative day 2 or later and 9 of them (5.3%) 
      required readmission (p = 0.36). The proportion of patients discharged within 23 
      hours increased in 2016 compared with previous years (25.8% v. 12.0%, p = 0.05). 
      Patients discharged within 23 hours had shorter chest tube duration (odds ratio 
      [OR] 0.20, 95% confidence interval [CI] 0.09-0.46, p < 0.001), lower clinical 
      stage disease (stages II-III v. stage I OR 0.07, 95% CI 0.01-0.52, p = 0.011), 
      lower pathologic stage lesions (stages II-III v. stage I OR 0.26, 95% CI 
      0.07-0.91, p = 0.035), fewer surgical complications (OR 0.04, 95% CI 0.01-0.30, p 
      = 0.002) and shorter operative time (surgery duration > 120 min OR 0.42, 95% CI 
      0.18-0.95, p = 0.04). Our exploratory prediction modelling showed that chest tube 
      duration, clinical stage and surgeon were the most influential predictors of 
      discharge within 23 hours. CONCLUSION: The only preoperative factors that 
      predicted shorter LOS in our cohort were clinical stage and surgeon. A 
      significant proportion of patients can be discharged safely by adopting a VATS 
      lobectomy 23-hour enhanced recovery pathway.
CI  - (c) 2020 Joule Inc. or its licensors.
FAU - Dumitra, Teodora-Cristiana
AU  - Dumitra TC
AD  - From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of 
      Surgery, McGill University Health Centre, Montreal, Que.
FAU - Molina, Juan-Carlos
AU  - Molina JC
AD  - From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of 
      Surgery, McGill University Health Centre, Montreal, Que.
FAU - Mouhanna, Jack
AU  - Mouhanna J
AD  - From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of 
      Surgery, McGill University Health Centre, Montreal, Que.
FAU - Nicolau, Ioana
AU  - Nicolau I
AD  - From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of 
      Surgery, McGill University Health Centre, Montreal, Que.
FAU - Renaud, Stephane
AU  - Renaud S
AD  - From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of 
      Surgery, McGill University Health Centre, Montreal, Que.
FAU - Aubin, Ludovic
AU  - Aubin L
AD  - From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of 
      Surgery, McGill University Health Centre, Montreal, Que.
FAU - Siblini, Aya
AU  - Siblini A
AD  - From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of 
      Surgery, McGill University Health Centre, Montreal, Que.
FAU - Mulder, David
AU  - Mulder D
AD  - From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of 
      Surgery, McGill University Health Centre, Montreal, Que.
FAU - Ferri, Lorenzo
AU  - Ferri L
AD  - From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of 
      Surgery, McGill University Health Centre, Montreal, Que.
FAU - Spicer, Jonathan
AU  - Spicer J
AD  - From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of 
      Surgery, McGill University Health Centre, Montreal, Que.
LA  - eng
PT  - Journal Article
DEP - 20200731
PL  - Canada
TA  - Can J Surg
JT  - Canadian journal of surgery. Journal canadien de chirurgie
JID - 0372715
SB  - IM
MH  - Aged
MH  - *Enhanced Recovery After Surgery
MH  - Feasibility Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pneumonectomy/*methods
MH  - Retrospective Studies
MH  - *Thoracic Surgery, Video-Assisted
MH  - Time Factors
PMC - PMC7458677
COIS- None declared.
EDAT- 2020/08/01 06:00
MHDA- 2020/11/20 06:00
PMCR- 2020/08/01
CRDT- 2020/08/01 06:00
PHST- 2020/08/01 06:00 [entrez]
PHST- 2020/08/01 06:00 [pubmed]
PHST- 2020/11/20 06:00 [medline]
PHST- 2020/08/01 00:00 [pmc-release]
AID - 063e349 [pii]
AID - 10.1503/cjs.002219 [doi]
PST - epublish
SO  - Can J Surg. 2020 Jul 31;63(4):E349-E358. doi: 10.1503/cjs.002219.