OA01.06 Early Post-Operative Ambulation after Thoracic Surgery - The WAVE Experience

Abstract

The occurrence of minimally invasive thoracic surgery interventions has grown steadily since the early 1990s, yet practice patterns for peri-operative management of these patients has lagged behind technical progress. Our thoracic program has created WAVE (Walking After VATS Experiment) which focuses on a multidisciplinary approach to early ambulation after thoracic surgery. A report from our first 3 years of data (July 2010 - July 2013) was presented at the 2013 IASLC meeting in Sydney, Australia. In response to the positive comments, we have continued our endeavor and in addition, investigated 30 day outcomes and length of stay for the homogeneous subset of anatomic lobectomy. Data was collected from a single surgeon at a single center and includes all consecutive thoracic surgical patients recovered through the WAVE program from July 2010 - July 2016. We excluded patients undergoing tracheostomy, endoscopic only procedures, and mediastinoscopy. Data was collected prospectively and analyzed retrospectively. From July 2010 to July 2016, 1152 patients were included for analysis. Within the 6 year period, 798/1152 patients (69%) walked any distance within one hour of extubation, 945/1152 patients (82%) walked 250 feet at any time while in the PACU, 721/1152 patients (63%) successfully walked the targeted distance of 250 feet within one hour of extubation and only 37/1152 patients (3%) were unable to ambulate at all in the PACU. There were no adverse events. The subset of anatomic lobectomies included 290 patients of which 197/290 patients (68%) walked any distance within one hour of extubation, 239/290 patients (82%) successfully walked 250 feet at any time while in the PACU, 175/290 patients (60%) achieved the target distance of 250 feet within one hour of extubation and only 5/290 patients (1.7%) were unable to ambulate at all in the PACU. The rate of 30 day post-operative complications compares favorably with the literature and are as follows: 4.1% atrial arrhythmia, 1.0% pneumonia, 6.6% air leak > 5 days, 0.7% DVT, 0.3% acute renal failure, 0.3% pulmonary embolism, 0% stroke, 0% myocardial infarction, 4.8% readmission and 0% mortality. Mean length of hospital stay was 1.6 days with a median of 1 day. Our “WAVE” experience reveals that aggressive early ambulation is effective in reducing post-operative complications and shortening length of stay. The platform is simple, reproducible and feasible for any thoracic surgical program. Key features for successful implementation include patient and family engagement, a multi-disciplinary team and administrative support.