An enhanced recovery pathway reduces duration of stay and complications after open pulmonary聽lobectomy

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• 作者：Amin Madani ; MD^a ; ^b ; Julio F. Fiore Jr. ; PhD^b ; Yifan Wang ; BSc^b ; Jimmy Bejjani ; MD^b ; Lojan Sivakumaran ; BSc^b ; Juan Mata ; MD^b ; Debbie Watson ; RN^a ; Franco Carli ; MD ; MPhil^c ; David S. Mulder ; MD^a ; Christian Sirois ; MD^a ; Lorenzo E. Ferri ; MD^a ; ^b ; Liane S. Feldman ; MD^a ; ^b ; ^{liane.feldman@mcgill.ca" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Surgery
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：158
• 期：4
• 页码：899-910
• 全文大小：295 K

文摘

Few studies have investigated the effectiveness of enhanced recovery pathways (ERP) for lung resection. This study estimates the impact of an ERP for lobectomy on duration of stay, complications, and readmissions.

Methods

Patients undergoing open lobectomy were identified from an OR database between 2011 and 2013. Beginning September 2012, all patients were managed according to a 4-day multidisciplinary ERP with written daily patient education treatment plans, multimodal analgesia, early diet, structured mobilization and standardized drain management. Pre-pathway (PRE) and post-pathway (POST) patients were compared in terms of duration of stay, complications, and readmissions.

Results

We identified 234 patients (PRE, 127; POST, 107). Groups were similar with respect to age, gender, American Society of Anesthesiologists score, and baseline pulmonary function. Compared with the PRE group, the POST group had decreased duration of stay (median, 6 [interquartile range (IQR), 5–7] vs 7 [6–10] days; P < .05), total complications (40 [37%] vs 64 [50%]; P < .05), urinary tract infections (3 [3%] vs 15 [12%]; P < .05), and chest tube duration (median, 4 [IQR, 3–6] vs 5 [4–7] days; P < .05), with no difference in readmissions (7 [7%] vs 6 [5%]; P < .05) or chest tube reinsertion (4 [4%] vs 6 [5%]; P < .05). Decreased duration of stay was driven by patients without complications (median, 5 [IQR, 4–6] vs 6 [5–7] days; P < .05).

Conclusion

Implementation of a multimodal ERP for lobectomy was associated with decreased duration of stay and complications with no difference in readmissions.