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Eur J Cardiothorac Surg 2006;29:271-275
© 2006 Elsevier Science NL

Outpatient thoracic surgical programme in 300 patients: clinical results and economic impact

^a Department of Thoracic Surgery, Sagrat Cor University Hospital, University of Barcelona, Viladomat 288, 08029 Barcelona, Spain
^b Department of Anaesthesiology, Sagrat Cor University Hospital, University of Barcelona, Barcelona, Spain

Received 30 September 2005; received in revised form 24 November 2005; accepted 2 December 2005.

^_* Corresponding author. Tel.: +34 934 948 922; fax: +34 934 052 641. (Email: lauremolins{at}comb.es).

Objective: To evaluate clinical aspects, results and the economic impact of the outpatient thoracic surgery programme (OTSP) developed in our Department. Methods: Prospective study of 300 patients who entered in the OTSP from April 2001 to March 2005. The procedures performed were videomediastinoscopy (MC), videothoracoscopic lung biopsy (LB) and videothoracoscopic bilateral thoracic sympathectomy (TS). All procedures were performed under general anaesthesia and patients were discharged in 4–6 h. We analyse demographic data, the substitution index (SI), the admission rate (AR) and readmission rate (RR) after the procedure. We calculate the economic impact of stay expenses on our hospital and on other Spanish hospitals. Results: The female/male ratio of the 300 patients was 83/217, with a mean age of 58.1 years (range: 15–85 years). There were no deaths. Mediastinoscopy was performed as outpatient procedure in 210 patients (mean age: 65.6 years) out of 244 total MC (SI = 86.1%). Two patients were admitted (AR = 0.95%) to observe a minimal pneumothorax and because of late night end. There were no readmissions after MC (RR = 0%). We included 32 ambulatory patients for lung biopsy (mean age: 61.5 years) out of 64 total LB (SI = 50.0%). One patient was admitted because of air leak (AR = 3.1%) and there were no readmissions after LB (RR = 0%). Fifty-eight patients were included in the OTSP for bilateral sympathectomy (mean age: 27.1 years) out of 83 total TS (SI = 69.9%); there were no admissions (AR = 0%) and one patient was readmitted after 9 days because of a hemothorax (RR = 1.7%). Sixty-four patients out of the 91 not included in the OTSP were included in an ‘afternoon surgical programme’ and dismissed the morning after surgery, without contraindication for their inclusion in the OTSP. The hospital's total stay saving was \#8364;12,668 (\#8364;88,226 if performed elsewhere), \#8364;42 per patient (\#8364;294 per patient if performed elsewhere). Conclusion: Video-assisted mediastinoscopy, lung biopsy and bilateral sympathectomy can be included safely in outpatient thoracic surgical programmes. The impact of the economic benefit of OTSP over the conventional hospitalisation depends on the Department's previous policy on hospital stays. Further experience is needed to increase the substitution index and expand the OTSP to other procedures.

Key Words: Ambulatory surgical procedures • Thoracic surgery • Day-case surgery • Mediastinoscopy • Thoracoscopic lung biopsy • Thoracic sympathectomy

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