4.1 Article

Fast-track rehabilitation following video-assisted pulmonary sublobar wedge resection: A prospective randomized study

Journal

JOURNAL OF MINIMAL ACCESS SURGERY
Volume 12, Issue 3, Pages 209-213

Publisher

MEDKNOW PUBLICATIONS & MEDIA PVT LTD
DOI: 10.4103/0972-9941.183483

Keywords

The word hospital discharge; pulmonary nodules; thoracoscopic surgery

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BACKGROUND: Postoperative morbidity and inhospital length of stay are considered major determinants of total health care expenditure associated with thoracic operations. The aim of this study was to prospectively evaluate the role of video-assisted thoracic surgery ( VATS) compared to mini-muscle-sparing thoracotomy in facilitating early recovery and hospital discharge after pulmonary sublobar wedge resections. PATIENTS AND METHODS: A total number of 120 patients undergoing elective pulmonary sublobar wedge resection were randomly assigned to VATS ( n = 60) or mini-muscle-sparing thoracotomy ( n = 60). The primary endpoint was time to hospital discharge. Postoperative complications, cardiopulmonary morbidity and 30-day mortality served as secondary endpoints. RESULTS: Patients' baseline demographic and clinical data did not differ among study arms as well as the number of pulmonary segments resected and the morphology of the nodular lesions. Total hospital stay was significantly shorter in patients assigned to the thoracoscopic technique as opposed to those who were operated using the mini-muscle-sparing thoracotomy approach ( 4 +/- 0.6 versus 4.4 +/- 0.6 days respectively, P = 0.006). Multivariate analysis revealed that VATS approach was inversely associated with longer inhospital stay whereas the number of resected segments was positively associated with an increased duration of hospitalization. Patients in the VATS group were less likely to develop atelectasis (>= 1 lobe) compared to those who underwent thoracotomy ( 0% versus 6.7% respectively, P = 0.042). Kaplan-Meier analysis revealed similar 30-day mortality rates in both study arms ( Log-rank P = 0.560). CONCLUSION: VATS was associated with shorter duration of hospitalization positively affecting the patients' quality of life and satisfaction. Significant suppression of the total cost of recovery after thoracoscopic pulmonary resections is expected.

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