Elsevier

Thoracic Surgery Clinics

Volume 18, Issue 3, August 2008, Pages 321-327
Thoracic Surgery Clinics

Outpatient Thoracic Surgery

https://doi.org/10.1016/j.thorsurg.2008.04.003Get rights and content

Although there has been a significant increase in ambulatory surgery activity, there is still great potential for an increase in outpatient thoracic surgery. Video-assisted mediastinoscopy, lung biopsy, and bilateral thoracic sympathectomy can be accomplished safely in a significant percentage as ambulatory patients. The impact of the economical benefit of an outpatient thoracic surgical program over the conventional hospitalization depends on the previous department's policy on hospital stay. Further experience is needed to increase the substitution index and expand the outpatient thoracic surgical program to other procedures.

Section snippets

Outpatient thoracic surgical program

The success of outpatient surgical programs requires the receptiveness of all involved professionals—surgeons, anesthesiologists, nursing, and administrative staff—and it requires further that this receptiveness is transmitted to the patients who are going to be included in the program. To achieve good results, it is important that the outpatient thoracic surgical program (OTSP) is integrated into an already-functioning outpatient surgical unit.

According to the authors' experience [5], the

Outpatient mediastinoscopy

Mediastinoscopy as a method to stage bronchogenic carcinoma was the first published indication of ambulatory surgery applied to thoracic surgery, and today it is the one most often used [1]. The feasibility of outpatient mediastinoscopy has been proven by several studies with a good degree of success [1], [5], [13], [14], [15], [16], but it is still widely performed in an inpatient setting.

In their publication, Vallieres and colleagues [1] described outpatient mediastinoscopy in 158 patients

Outpatient thoracic sympathectomy

In recent years thoracoscopic sympathectomy (TS) has become the most widely used approach in the management of primary hyperhidrosis and facial blushing [17]. Although the procedure is usually performed in young, otherwise healthy patients, in the previous years, most of them ended up staying one night because of pain, nausea, or vomiting. The key to including these patients in the outpatient program is the anesthetic technique and premedication with antiemetic agents and analgesia, including

Outpatient lung biopsy

Videothoracoscopic lung biopsy (VATS-LB) has become an increasingly accepted approach for the diagnosis of patients with both diffuse interstitial lung disease [26], [27] and pulmonary nodules [28] but, to date, very little has been published on outpatient lung biopsy [5], [29], [30].

In general practice, after a videothoracoscopic lung biopsy, the “need” for a postoperative chest drainage is still the reason that hinders patients from being discharged home. Russo and colleagues [31], in a

Economic impact

Increasing the percentage of operations done as outpatient surgery should save money to the health care system and allow us to care for more patients with the same amount of resources. The impact of the economic benefit depends on the previous policy on hospital stay for the same procedures performed by conventional hospitalization.

In the authors' previous experience, the economic impact was applied to the reduction in variable hospital costs (bed, meals, energy, laundry, and so on) over

Comments

Because of the underlying pathology of the patients, the authors' think that it will be difficult to improve the lung biopsy substitution index, but the mediastinoscopy and thoracic sympathectomy substitution indices could rise to nearly 99%. In the authors' program, 108 out of 154 patients not included in the OTSP (70.1%) were operated on in an “afternoon surgical program” and dismissed the morning after surgery with no objective contraindication for ambulatory surgery. Today, these patients

Summary

In summary, from the different alternatives to conventional hospitalization developed in the last decades, outpatient surgery has been the one with the greatest growth. However, only few studies have been reported on thoracic surgery and there is still great potential for an increase in outpatient thoracic surgery. The aim of this article has been to evaluate the clinical aspects, results, and economical impact of an outpatient thoracic surgery program (OTSP). Video-assisted mediastinoscopy,

Acknowledgments

The authors thank Antoni Tobella, PhD, for his assistance in the revision of this article.

References (37)

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