Outpatient Thoracic Surgery
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.
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Cited by (14)
Outpatient Thoracoscopic Mediastinal Biopsy: A Safe and Cost-Effective Approach
2020, Annals of Thoracic SurgeryThe benefits of digital thoracic drainage system for outpatients undergoing pulmonary resection surgery
2011, Revista Portuguesa de PneumologiaCitation Excerpt :Prospective, comparative protocols were early introduced in order to demonstrate that drainage time is indeed shortened,6,7 this includes our study which compares two different types of DTDS with the traditional system.8 Based on our experience that this system works and having enough proven experience in Outpatient Thoracic Surgery Programmes,9 we considered the possibility of offering this system to some carefully selected patients. This study was reviewed and approved by the Hospital Universitari Sagrat Cor ethics committee.
Ultrasonographic identification of peripheral pulmonary nodules through uniportal video-assisted thoracic surgery
2011, Annals of Thoracic SurgeryCitation Excerpt :However, the visualization of the nodule by the ultrasonographic probe appeared straightforward also to the inexperienced eye. In the recent literature, there is a notable trend toward expanding the domain of outpatient thoracic surgery under the pressure of third-party payers, mass media, and patients [9, 10]. The uniportal VATS approach in the awake patient can be considered a potential alternative for selected cases, especially when solitary pulmonary nodules represent a diagnostic dilemma.
Guidelines on Surgery of the Thoracic Sympathetic Nervous System
2011, Archivos de Bronconeumologia