ONE-DAY ADMISSION FOR LUNG LOBECTOMY - AN INCIDENTAL RESULT OF A CLINICAL PATHWAY

Background. Most complications after lung lobectomy are related to pai n, narcotic analgesia, and inactivity. When the operation is performed with the goal of minimizing postoperative pain, and when rapid restor ation of activity and patient independence can be achieved, most posto perative complications can be obviated and early discharge can be atta ined. Methods. Since March 1996, we have performed 10 consecutive elec tive major lung resections (8 lobectomies and 2 bilobectomies) for neo plastic (n = 8) and benign inflammatory (n = 2) lesions. Of the 10 pat ients, 4 were men and 6 were women ranging in age from 58 to 77 years (mean age, 66 years). Extensive preoperative patient and family educat ion was provided in the surgeon's office. Same-day admission was follo wed by an oblique muscle-sparing minithoracotomy to access the chest c avity. A meticulous operation, with special attention to minimizing ai r leak and postoperative discomfort, was performed. Intercostal nerve cryolysis was used as the main method of analgesia. Results. All patie nts underwent the planned operation through a minithoracotomy and were extubated in the operating room. All patients exhibited normal ipsila teral shoulder girdle mobility in the recovery room and none required intravenous narcotics after leaving this unit. All patients were out o f bed the day of the operation. The chest tube was removed the night o f the operation in 2 patients, the morning after the operation in 6 pa tients, and on the second postoperative day in 1 patient. One patient who was discharged with a Heimlich valve had this device removed in th e office 4 days after the operation. After the chest tubes were remove d, there were no instances of pneumothorax. All 10 patients were able to ambulate independently on the first postoperative day. Eight patien ts were discharged home the morning after the operation and 2 on the s econd postoperative day. None of the patients have required readmissio n related to their operation or have exhibited evidence of postthoraco tomy pain syndrome. Conclusions. We have developed a clinical pathway based on patient education, meticulous minimally invasive operation, c ryoanalgesia, and quick resumption of physical activity. Our prelimina ry experience with this approach has shown minimal morbidity, rapid re storation to preoperative status, and, for most patients, a 1-day hosp ital stay after major lung resection. (C) 1998 by The Society of Thora cic Surgeons.