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

  • Park, Seong-Yong (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Park, In-Kyu (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hwang, Yoo-Hwa (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Byun, Chun-Sung (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Bae, Mi-Kyung (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Chang-Young (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2010.10.15
  • Accepted : 2011.05.10
  • Published : 2011.06.05

Abstract

Background: Following 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 Methods: 316 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. Results: Early 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. Conclusion: Immediate postoperative care after lobectomy for lung cancer in a GTW was safe and cost-effective without compromising outcomes in low-risk patients.

Keywords

References

  1. Knott-craig CJ, Howell CE, Parsons BD, Paulsen SM, Brown BR, Elkins RC. Improved results in the management of surgical candidates with lung cancer. Ann Thorac Surg 1997;63:1405-10. https://doi.org/10.1016/S0003-4975(97)00252-X
  2. Licker M, de Perrot M, Höhn L, et al. Perioperative mortality and major cardio-pulmonary complications after lung surgery for non-small cell carcinoma. Eur J Cardiothorac Surg 1999;15:314-9. https://doi.org/10.1016/S1010-7940(99)00006-8
  3. Stephan F, Boucheseiche S, Hollande J, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest 2000;118:1263-70. https://doi.org/10.1378/chest.118.5.1263
  4. Licker MJ, Widikker I, Robert J, et al. Operative mortality and respiratory complications after lung resection for cancer: Impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg 2006;81:1830-8. https://doi.org/10.1016/j.athoracsur.2005.11.048
  5. Brunelli A, Pieretti P, Al Refai M, et al. Elective intensive care after lung resection: a multicentric propensity-matched comparison of outcome. Interact Cardiovasc Thorac Surg 2005;4:609-13. https://doi.org/10.1510/icvts.2005.116459
  6. Dhond G, Ridley S, Palmer M. The impact of a high-dependency unit on the workload of an intensive care unit. Anaesthesia 1998;53:841. https://doi.org/10.1046/j.1365-2044.1998.00522.x
  7. Wyser C, Stulz P, Soler M, et al. Prospective evaluation of an algorithm for the functional assessment of lung resection candidates. Am J Respir Crit Care Med 1999;159:1450-6. https://doi.org/10.1164/ajrccm.159.5.9809107
  8. Schweizer A, Khatchatourian G, Hohn L, Spiliopoulos A, Romman J, Licker M. Opening of a new postanesthesia care unit: impact on critical care utilization and complications following major vascular and thoracic surgery. J Clin Anesth 2002;14:486-93. https://doi.org/10.1016/S0952-8180(02)00403-8
  9. Melley DD, Thomson EM, Page SP, Ladas G, Cordingley J, Evans TW. Incidence, duration and causes of intensive care unit admission following pulmonary resection for malignancy. Intensive Care Med 2006;32:1419-22. https://doi.org/10.1007/s00134-006-0269-4
  10. Romano P, Mark D. Patient and hospital characteristics related to in-hospital mortality after lung cancer resection. Chest 1992;101:1332-7. https://doi.org/10.1378/chest.101.5.1332
  11. Ferguson MK, Vigneswaran WT. Diffusing capacity predicts morbidity after lung resection in patients without obstructive lung disease. Ann Thorac Surg 2008;85:1158-65. https://doi.org/10.1016/j.athoracsur.2007.12.071
  12. Pieretti P, Alifano M, Roche N, et al. Predictors of an appropriate admission to an ICU after a major pulmonary resection. Respiration 2006;73:157-65. https://doi.org/10.1159/000088096
  13. Ghosh S, Steyn R, Marzouk J, Collins FJ, Rajesh PB. The effectiveness of high dependency unit in the management of high risk thoracic surgical cases. Eur J Cardiothorac Surg 2004;25:123-6. https://doi.org/10.1016/S1010-7940(03)00610-9

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