Immediate Postoperative Care in the General Thoracic Ward Is Safe for Low-risk Patients after Lobectomy for Lung Cancer

Abstract

BackgroundFollowing major lung resection, patients have routinely been monitored in the intensive care unit (ICU). Recently, however, patients are increasingly being placed in a general thoracic ward (GTW). We investigated the safety and efficacy of the GTW care after lobectomy for lung cancer.Materials and Methods316 patients who had undergone lobectomy for lung cancer were reviewed. These patients were divided into two groups: 275 patients were cared for in the ICU while 41 patients were care for in the GTW immediately post-operation. After propensity score matching, postoperative complications and hospital costs were analyzed. Risk factors for early complications were analyzed with the whole cohort.ResultsEarly complications (until the end of the first postoperative day) occurred in 11 (3.5%) patients. Late complications occurred in 42 patients (13.3%). After propensity score matching, the incidence of early complications, late complications, and mortality were not different between the two groups. The mean expense was higher in the ICU group. Risk factors for early complications were cardiac comorbidities and low expected forced expiratory volume in one second. The location of postoperative care had no influence on outcome.ConclusionImmediate postoperative care after lobectomy for lung cancer in a GTW was safe and cost-effective without compromising outcomes in low-risk patients.

Perioperative Factors for Predicting the Need for Postoperative Intensive Care after Major Lung Resection

“…Second, because this study was performed retrospectively by reviewing electronic medical records, there may be inherent selection biases. Third, this study was conducted using a relatively small number of patients; however, 340 patients is not a small number compared to the number of patients in previous studies on ICU admission or postoperative complications after lung resection [2,3,5,6].…”

“…Surgery-related mortality due to pulmonary resection is relatively low, but pulmonary resection can cause various complications such as intraoperative bleeding, arrhythmia, myocardial infarction, and respiratory failure [1,2]. Thus, in most thoracic surgical centers, postoperative admission to an intensive care unit (ICU) is planned for patients who will be undergoing major lung resection, often only for surveillance purposes [3]. However, ICU admission only for surveillance is not desirable in terms of cost-effectiveness and could result in an overuse of ICU resources [3,4].…”

“…Thus, in most thoracic surgical centers, postoperative admission to an intensive care unit (ICU) is planned for patients who will be undergoing major lung resection, often only for surveillance purposes [3]. However, ICU admission only for surveillance is not desirable in terms of cost-effectiveness and could result in an overuse of ICU resources [3,4]. Increased use of the ICU for surveillance purposes can lead to limited ICU resources; additionally, patients who require intensive care may be overlooked, and their conditions may worsen in general wards.…”

Early and Interdisciplinary Physiotherapy in a Patient in the Intensive Care Unit with a Bronchopulmonary Fistula after Thoracic Fenestration: A Case Report

“…The effectiveness of respiratory rehabilitation based on the elements of the PNF method to increase respiratory functions was also demonstrated by authors who carried out research using resistance and strengthening respiratory exercises in neurological patients in ICUs [8,9]. Park et al recommended indirect work on the respiratory system when direct work on the ribs is impossible so that the abdominal muscles are stimulated [10]. It was also demonstrated that bedside cycling can improve rehabilitation in critically ill patients as it ensures low-intensity movement and introduces activity to patients after pneumonectomy which affects the individual improvement of the body's capacity [11].…”

Who Needs to Be Allocated in ICU after Thoracic Surgery? An Observational Study

“…This indiscriminate use of ICU services following lung resection contradicts the European Respiratory Society/European Society of Thoracic Surgeons guideline recommendation that admission to the ICU after thoracotomy should not be done on a regular basis. Moreover, it might lead to clinical problems such as increased risk of nosocomial infection or delirium and to ICU bed shortage and increase in hospital expenditure [ 1 – 3 ].…”