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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2016 January;82(1):15-21
Feasibility and results of a fast-track protocol in thoracic surgery
Virginie DUMANS-NIZARD 1, Jeff GUEZENNEC 1, François PARQUIN 2, Philippe PUYO 2, Edouard SAGE 2, Rachida ABDAT 1, Virginie VAILLANT 1, Alain CHAPELIER 2, Jean-François DREYFUS 3, Marc FISCHLER 1, Morgan LE GUEN 1 and the Foch Thoracic Anesthesiology Group ✉
1 Department of Anesthesiology, Foch Hospital, France and the University of Versailles Saint Quentin in Yvelines, France; 2 Department of Thoracic Surgery, Foch Hospital, Suresnes, France and the University of Versailles Saint Quentin in Yvelines, Yvelines, France; 3 Direction of clinical research and innovation, Foch Hospital, Suresnes, France
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.
CONCLUSION: A program for early rehabilitation is feasible after thoracotomy. Chest drainage and organization to optimize the length of stay are crucial points.