HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eduardo A. Tovar Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tovar, E. A. Search for Related Content PubMed PubMed Citation Articles by Tovar, E. A. Related Collections Lung - other Professional affairs

Eur J Cardiothorac Surg 2001;20:449-454
© 2001 Elsevier Science NL

One-day admission for major lung resections in septuagenarians and octogenarians: a comparative study with a younger cohort

^a Department of Cardiothoracic Surgery, University of California, Irvine Medical Center, Orange, CA, USA
^b Department of Cardiothoracic Surgery, St. Jude Medical Center, Fullerton, CA, USA

Received 8 October 2000; received in revised form 17 May 2001; accepted 31 May 2001.

Suite 301, 100 E. Valencia Mesa Drive, Fullerton, CA 92835, USA. Tel.: +1-714-870-0789; fax: +1-714-870-0435
e-mail: etovarmd{at}aol.com

Objectives: The proportion of elderly patients presenting with a potentially resectable lung malignancy is increasing. Due to their greater operative risk, these patients are frequently offered a lesser resection, non-surgical treatment, or no treatment at all. The goal of this study is to determine whether septuagenarians and octogenarians undergoing video-assisted major lung resections benefit from an accelerated recovery program as much as younger patients, enabling them to be discharged after an overnight hospital stay. A short length of hospital stay, per se, does not represent the actual goal of this clinical care pathway. Instead, it should be considered as a measurement of how quickly functional ability is restored. Methods: Of 65 consecutive patients who underwent major lung resections, 30 were 70 years of age or older (25 septuagenarians and five octogenarians; mean age, 75.7 years). Forty-six lobectomies, eight bilobectomies, and 11 pneumonectomies were performed using a video-assisted muscle-sparing minithoracotomy. In the elderly group, 24 lobectomies, three bilobectomies, and three pneumonectomies were performed. Patient and family education, multimodal analgesia, and an accelerated recovery program were implemented for all patients and the results were compared between the elderly group and the younger cohort. Discharge criteria included: (a), pain controlled with oral analgesics; (b), clear lungs in chest radiograph and without evidence of pneumothorax with the chest tube off suction; (c), independent ambulation; (d), adequate oxygenation; and (e), patient's acceptance and with home support. Whenever these criteria were met, regardless of how early or late during the hospital stay, the patient was released from the hospital. Results: There were no deaths within 30 days of the operation and only three complications (one in the elderly group), and none of them altered the patients’ clinical courses. The mean length of hospital stay for the whole group was 1.2 days (54 patients had an overnight hospital stay and two were outpatient procedures). The mean length of hospital stay for the elderly group was 1 day (27 patients had an overnight hospital stay and one was an outpatient procedure). None of the patients required conversion to a standard posterolateral thoracotomy and no patient required readmission related to an early discharge. Conclusions: These data show that it is feasible to create strategies to prevent or attenuate physiological derangements during surgery while performing major lung resections. As a result, an early recovery with few complications has been attained, allowing patients to consistently meet stringent discharge criteria after only an overnight hospital stay, even in the case of septuagenarians and octogenarians.

Key Words: Video thoracoscopy • Lung surgery • Neoplasms, Lung • Carcinoma • Bronchogenic • Length of stay • Aged

This article has been cited by other articles:

				M. Al-Abdullatief, A. Wahood, N. Al-Shirawi, Y. Arabi, M. Wahba, M. Al-Jumah, S. Al-Sheha, and N. Yamani Awake anaesthesia for major thoracic surgical procedures: an observational study Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 346 - 350. [Abstract] [Full Text] [PDF]

				P. Lee and H. G. Colt A Spray Catheter Technique for Pleural Anesthesia: A Novel Method for Pain Control Before Talc Poudrage Anesth. Analg., January 1, 2007; 104(1): 198 - 200. [Abstract] [Full Text] [PDF]

				G. Varela, J. L. Aranda, M. F. Jimenez, and N. Novoa Emergency hospital readmission after major lung resection: prevalence and related variables Eur. J. Cardiothorac. Surg., September 1, 2004; 26(3): 494 - 497. [Abstract] [Full Text] [PDF]