Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway

Muehling, Bernd M.; Halter, G; Schelzig, Hubert; Meierhenrich, Rainer; Steffen, Peter R. P.; Sunder‐Plassmann, L.; Orend, Karl-Heinz

doi:10.1016/j.ejcts.2008.04.009

Cited by 173 publications

(150 citation statements)

References 25 publications

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“…Frequently, such schemes are viewed with skepticism due to fears of a higher incidence of postoperative complications. In line with findings from a large observational series [12], a recently published randomized controlled trial (RCT) comparing "fast track" and conventional perioperative care for lung resections demonstrated the opposite by showing significantly reduced morbidity in the "fast track" arm [17]. In our patients, we also observed a reduction in morbidity, which did not however reach statistical significance because of low case numbers.…”

Section: Discussionsupporting

confidence: 89%

Effects of a clinical pathway for video-assisted thoracoscopic surgery (VATS) on quality and cost of care

Schwarzbach

Ronellenfitsch

Wang

et al. 2009

Langenbecks Arch Surg

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Section: Discussionsupporting

confidence: 89%

Effects of a clinical pathway for video-assisted thoracoscopic surgery (VATS) on quality and cost of care

Schwarzbach

Ronellenfitsch

Wang

et al. 2009

Langenbecks Arch Surg

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“…In general, the application of standardized elements of care contributed to reduce hospital stay. However, inconsistent findings were reported in terms of morbidity, mortality and re-admission rates (6)(7)(8).…”

mentioning

confidence: 94%

Enhanced recovery pathways version 2.0 in thoracic surgery

Brunelli¹,

Imperatori²,

Droghetti³

2018

J. Thorac. Dis.

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Enhanced recovery pathways (ERPs) after surgery is a multimodal plan of care based on the application of multiple standardized evidence-based elements with the aim to improve the perioperative patient experience and surgical outcomes. These standardized elements are not just limited to the postoperative period but refer to the preoperative phase and obviously the surgical procedure. ERP is based on the concept of "marginal gains", well known in sport. Applied in isolation, the individual elements may have not a great effect on the outcome, but when applied together they act synergistically (1).The concept of ERP has been popularized in other specialties, particularly colorectal surgery, in which this practice has shown great benefits compared to standard care (2).However, thoracic surgeons are used to the elements of ERP, even though these were not badged as such. Certain practices, such as fluid balance, pain management, early mobilization, postoperative rehabilitation, are used in many thoracic surgery centers since decades. Several years ago, Cerfolio and colleagues (3,4) for instance identified modifiable and non-modifiable factors, which could contribute to improve fast track rate. Among the modifiable factors, the most relevant were the management of chest tubes, pain control, and social support plans. In spite of the factors contributing to ERP are well embedded in the thoracic surgery practice, the literature on ERP in our specialty is scant (5). Only few studies tried to analyze the effect of a standardized practice on the outcome after lung surgery. These studies were inconsistent in the elements they used to define a fast track protocol. The findings were also inconsistent. In general, the application of standardized elements of care contributed to reduce hospital stay. However, inconsistent findings were reported in terms of morbidity, mortality and re-admission rates (6-8).In all specialties, minimally invasive surgery represents the most important element in an ERP program. Yet so far most of the studies in thoracic surgery failed to include patients submitted to video-assisted thoracoscopic surgery (VATS), mostly because they were conducted prior to the widespread use of this approach.In a recent study, we were not able to find any difference in terms of morbidity, mortality and length of stay between patients submitted to VATS lobectomy before and after the introduction of a formal ERP program at our institution (9). The most likely explanation for this rather disappointing finding is that the majority of the key elements, which constitute ERP were already in place before the start of a formal ERP (i.e., use of a single drain, use of a digital drain system, similar pain management, postoperative rehabilitation, early oral feeding, etc.). The addition of few other elements such as the assumption of energy drinks before surgery to reduce the catabolic response or the use of warming blanket to prevent shivering and hypothermia among the others are unlikely to provide any benefits in a population who...

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“…Various procedures have been adopted to decrease the incidence of PPC. Muehling et al [40] implemented a multimodal therapeutic approach, the so called fast track clinical pathway, to reduce morbidity and mortality after major lung surgery. It consisted in preoperative patient education about postoperative care, preoperative fasting limited to 2 h preoperatively, pain control with thoracic epidural catheter between T5 and T9 accompanied by NSAIDs, and enteral feeding and ambulation started on the evening of the operation.…”

Section: Preventing Postoperative Pulmonary Complications (Ppc)mentioning

confidence: 99%