Thoracic Surgery Patients Research Articles

Utilizing Forced Vital Capacity to Predict Low Lung Compliance and Select Intraoperative Tidal Volume During Thoracic Surgery.

Tidal volume selection during mechanical ventilation utilizes dogmatic formulas that only consider a patient's predicted body weight (PBW). In this study, we investigate whether forced vital capacity (FVC) (1) correlates better to total lung capacity (TLC) than PBW, (2) predicts low pulmonary compliance, and (3) provides an alternative method for tidal volume selection. One hundred thirty thoracic surgery patients had their preoperative TLC calculated via 2 methods: (1) pulmonary function test (PFT; TLCPFT) and (2) computed tomography 3D reconstruction (TLCCT). We compared the correlation between TLC and PBW with the correlation between TLC and FVC to determine which was stronger. Dynamic pulmonary compliance was then calculated from intraoperative ventilator data and logistic regression models constructed to determine which clinical measure best predicted low compliance. Ratios of tidal volume/FVC plotted against peak inspiratory pressure were utilized to construct a new model for tidal volume selection. Calculated tidal volumes generated by this model were then compared with those generated by the standard lung-protective formula Vt = 7 cc/kg. The correlation between FVC and TLC (0.82 for TLCPFT and 0.76 for TLCCT) was stronger than the correlation between PBW and TLC (0.65 for TLCPFT and 0.58 for TLCCT). Patients with very low compliance had significantly smaller lung volumes (forced expiratory volume at 1 second, FVC, TLC) and lower diffusion capacity of the lungs for carbon monoxide when compared with patients with normal compliance. An FVC cutoff of 3470 cc was 100% sensitive and 51% specific for predicting low compliance. The proposed equation Vt = FVC/8 significantly reduced calculated tidal volume by a mean of 22.5% in patients with low pulmonary compliance without affecting the mean tidal volume in patients with normal compliance (mean difference 0.9%). FVC is more strongly correlated to TLC than PBW and a cutoff of about 3.5 L can be utilized to predict low pulmonary compliance. The equation Vt = FVC/8 reduced mean calculated tidal volume in patients with low pulmonary compliance and/or small lungs.

MA 08.05 Surviving Lung Cancer, an Analysis of the Patient Concerns Identified in a Nurse-Led Follow-Up Clinic after Thoracic Surgery

Using evidence based follow up guidelines, our nurse led follow-up clinic was established in December 2012. All post-operative thoracic surgery patients are seen, including patients with primary lung cancer. We evaluated problems and issues patients identified related to their post-operative recovery and follow-up period. Data was collected prospectively from December 2012 to March 2017. This included information for each patient on surgery, pathology, TNM stage, follow-up plan and smoking status. We recorded additional issues raised by patients. Data was analyzed to generate descriptive statistics of post-operative problems. There were 546 patient episodes in 189 clinics for 285 patients with primary lung cancer. Of the 285 patients 70 (25%) were smokers in the 6 weeks prior to surgery. 171 (60%) were ex-smokers and 44 (15%) had never smoked. 32 (11%) patients smoked after surgery, all except one were pre-operative smokers. Smoking cessation was a concern after surgery with 44% of the pre-operative smokers restarting smoking post-operatively. The number of patients seen at each follow-up interval and the issues identified are shown in the table below. The most frequent issues reported by patients after thoracic surgery are pain, respiratory issues and anxiety. 80% of patients report problems at their first follow-up appointment after surgery, decreasing to 59% at five years. Respiratory issues are common in this group of patients who often have co-existing lung disease. Anxiety, most commonly associated with fears about recurrence of disease, remains a problem throughout the follow-up period. 31% of patients had abnormal imaging at one or more appointments. The findings indicate the extent of physical, psychological and lifestyle (e.g. smoking) concerns in post-operative follow-up. A new telephone follow-up clinic has recently been introduced to address these needs. Further investigation with objective assessment and scoring of symptoms would improve the quality of the data collected.

Application of modified lateral position in thoracic surgery

Objective To optimize the lateral position of the operation, to improve the comfort of the lateral decubitus patients, to expose the incision adequately, and to improve the nursing quality of lateral decubitus surgery. Methods A total of 60 cases of thoracic surgery patients with lateral decubitus were divided into the control group and the test group according to the random number table method, 30 cases each. The control group used traditional lateral decubitus placement method, experimental group through the method and fixed on the traditional method of placing lateral limbs was improved, used in thoracic surgery especially in thoracoscopic surgery. The effect was compared between two groups. Results The time between the experimental group and the control group was respectively (5.6 ± 0.7), (9.0 ± 0.5) min, and the difference between the two groups was statistically significant (t= 26.944, P < 0.01). In the two groups, the muscle soreness of 24 – 48 h after operation was 1 and 12 cases, and 2 groups were statistically significant (χ2= 13.35, P < 0.01). The postoperative satisfaction of the two groups of surgeons, anesthesiologists and nurses was statistically significant (Z=-2.573, P < 0.01). Conclusions The modified lateral application in thoracic surgery is superior than the traditional lateral position, lateral position display method of time and labor saving, energy saving, expand the operation field, improve patient comfort, reduce costs, and improve the safety of nursing quality in operation room. Key words: Surgical position; Improved lateral; Position; Function

Impact of Liposomal Bupivacaine on Length of Hospitalization in Thoracic Surgery Patients

Dominguez, Dana MD; Ely, Sora MD; Bach, Cynthia T.; Lee, Tina M.; Velotta, Jeffrey B. MD Author Information

Feasibility and Impact of Focused Intraoperative Transthoracic Echocardiography on Management in Thoracic Surgery Patients: An Observational Study

Intraoperative focused transthoracic echocardiography (TTE) is feasible and has an effect on the management of hemodynamically unstable surgical patients. Furthermore, in noncardiac thoracic surgery, TTE might provide additional information for hemodynamic treatment. Transthoracic accessibility during thoracic surgical interventions is assumed to be difficult. For patients positioned on their right side, a modified subcostal transthoracic view might be helpful. A prospective observational study. Single-center university hospital. The study comprised 105 consecutive patients undergoing noncardiac thoracic surgery. Focused TTE was performed during anesthetic induction after intubation for mechanical ventilation. Intraoperative focused TTE, after positioning and draping for surgery, was attempted again for all 105 patients. Changes in patient management due to the results of the TTE were documented and analyzed. Presurgical TTE with mechanical ventilation was applied successfully in 98.1% of 105 patients. Intraoperative imaging was successful in 90 patients (85.7%). Results of intraoperative TTE led to the modification of perioperative management in 39 patients (37.1%), 20 (22.0%) of these during surgery. TTE in noncardiac thoracic surgery is feasible using a modified subcostal view and has an effect on hemodynamic management in a considerable number of patients.

The prevalence of pulmonary complications after thoracic and abdominal surgery and associated risk factors in patients admitted at a government hospital in Harare, Zimbabwe-a retrospective study

BackgroundThe burden of HIV/AIDS in Sub-Saharan Africa has presented unusual and challenging acute surgical problems across all specialties. Thoraco-abdominal surgery cuts through muscle and thereby disrupts the normal anatomy and activity of the respiratory muscles leading to reduced lung volumes and putting the patients at greater risk of developing post-operative pulmonary complications (PPCs). PPCs remain an important cause of post-operative morbidity, mortality, and impacts on the long-term outcomes of patients post hospital discharge. The objective of the study was to determine the pulmonary complications developing after abdominal and thoracic surgery and the associated risks factors.MethodsA retrospective records review of all abdominal and thoracic surgery patients admitted at a central hospital from January 2014 to October 2014 was done. Data collected included demographic data, surgical history, comorbidities and the PPCs present.ResultsOut of the 92 patients whose records were reviewed, 55 (59.8%) were males and 84 (91.3%) had abdominal surgery. The mean age of the patients was 42.6 years (SD = 18.4). The common comorbidities were HIV infection noted in 14(15.2%) of the patients and hypertension in 10 (13.0%). Thirty nine (42.4%) developed PPCs and the most common complications were nosocomial pneumonia in 21 (22.8%) patients, ventilator associated pneumonia in 11 (12.0%), and atelectasis in 6 (6.5%) patients. Logistic regression showed that a history of alcohol consumption, prolonged surgery, prolonged stay in hospital or critical care unit, incision type, and comorbidities were significant risk factors for PPCs (p < 0.05). The mortality rate was 10.9%.ConclusionPPCs like nosocomial and ventilator associated pneumonia were common and were associated with increased morbidity and adversely affected clinical outcomes of patients. HIV and hypertension presented significant comorbidities which the health team needed to recognize and address. Strategies to reduce the occurrence of PPCs have to be implemented through coordinated efforts by the health practitioners as a team during the entire perioperative period.

Comparison of outcomes between muscle-sparing thoracotomy and video-assisted thoracic surgery in patients with cT1 N0 M0 lung cancer

ObjectiveTo compare short-term complications and long-term survival outcomes between muscle-sparing thoracotomy (MST) and video-assisted thoracic surgery (VATS) groups using a propensity-score matching process. MethodsOne thousand eighty-three patients with cT1 N0 M0 lung cancer from January 2009 to December 2014 who underwent lobectomy and a systematic lymph node dissection were retrospectively included, and statistical analyses including a propensity-score matching process were used to compare short-term and long-term outcomes. ResultsBefore propensity-score matching, for short-term surgical outcomes, the VATS group had fewer chest tube dwelling days (P < .001), less chest tube output (P < .001), shorter hospital stay, and fewer postoperative complications (P = .015). For long-term survival outcomes, the VATS group had a longer recurrence-free survival (P < .001) and overall survival (P < .001). After propensity-score matching, for short-term surgical outcomes, the VATS group had fewer chest tube dwelling days (P < .001), less chest tube output (P < .001), shorter hospital stay (P = .002), and fewer postoperative complications (P = .008). There was no difference in recurrence-free survival and overall survival between the 2 groups (P = .158 and P = .639, respectively). ConclusionsVATS is less invasive and is associated with shorter length of hospital stay and fewer postoperative complications. The 2 surgical approaches have equivalent long-term survival outcomes.

Assessing the clinical feasibility of implementing a novel assessment of frailty: The electronic Rapid Fitness Assessment in diverse thoracic surgery clinics.

e21687 Background: The American College of Surgeons and American Geriatrics Society recommend a geriatric/frailty assessment (GA) in the preoperative evaluation. We previously reported the development and implementation of the electronic Rapid Fitness Assessment (eRFA) in geriatric clinics. The eRFA captures data on multiple GA domains, including functional activity, social support, emotional well-being, weight loss, polypharmacy, and cognitive function. We now report the feasibility of clinical implementation of the eRFA in diverse thoracic surgery outpatient settings. Methods: Over 5 months, the eRFA was implemented until used by 5 surgeons in 2 outpatient clinics. All patients presenting for initial consultation were to complete the self-reported components of the eRFA by themselves or with the help of caregivers using a tablet or desktop computer, before coming to the clinic or in the clinic. A nurse performed the timed “get up and go” test and MiniCog test. A summary report was prepared for the clinician by the time of the encounter, and the data were stored in a database and as part of the electronic medical record. Time to complete the eRFA was recorded. Results: Since initiation in 9/2016, 78% of patients (65/83; median age, 71 [range, 20-88]; 31F:34M) completed the eRFA at initial consultation with a thoracic surgeon. Median time to complete was 9 min (range, 2-50); 75% of surveys were completed by the patient alone, 23% with a caregiver, and 3% by a caregiver alone. A large number of geriatric syndromes were uncovered: 26% of patients (17/65) had abnormalities in word recall, clock drawing, and/or timed “get up and go”; 41% (27/65) needed assistance with activities of daily living; 9% needed a cane or other support to ambulate; and 26% had at least 1 fall in the last year. Conclusions: Administration of the eRFA, an electronic assessment of patient frailty, is feasible in the initial evaluation of thoracic surgery patients. Future steps include characterization of functional reserve of patients considered for surgery, creation of prognostic models, and development of clinical trials to assess means of improving outcomes in this population of patients at risk.

0629 PREOPERATIVE STOP-BANG SCORES AND THEIR ASSOCIATION WITH POSTOPERATIVE DELIRIUM AMONG THORACIC SURGERY PATIENTS

The presence of obstructive sleep apnea (OSA) is associated with significant perioperative morbidity and mortality, including a predisposition to develop delirium. Delirium in the postoperative period is associated with longer hospital stays, increased healthcare costs, long-term cognitive decline, and increased mortality. The STOP-BANG questionnaire is a validated tool which screens for OSA and a score of ≥ 3 is considered high-risk for OSA. This study tests the hypothesis that higher preoperative STOP-BANG scores are associated with an increased duration of postoperative delirium and longer hospital stays. This observational cohort study included 128 thoracic surgery patients (n=80 esophagectomy; n=48 other thoracotomy). Each patient completed the STOP-BANG questionnaire preoperatively. Postoperative delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU) scale. Richmond-Agitation-Sedation Scale (RASS) was used to assess level of sedation. Coma was defined as RASS scores of -4 or -5. Of the 128 patients, 97 (76%) had STOP-BANG scores ≥ 3. Patients in this high-risk group were more likely to be male (82.5%), older (mean 62.8 years), have a higher Charlson’s comorbidity burden (mean 3.1), and had more esophagectomies (67%). No differences were observed in the incidence of delirium (26.8% vs 19.4%; p=0.481), delirium days (0.4 vs 0.2; p=0.297), ICU days (2.8 vs 2.2; p=0.072), or total hospital days (10.1 vs 8.4; p=0.019). After adjusting for age, gender, surgery type, comorbidities, and BMI, the high-risk group had a longer duration of acute brain dysfunction (coma/delirium) (1.4 days vs 0.9 days; p=0.04). The results show that preoperative STOP-BANG scores ≥ 3 are associated with a significantly longer duration of post-operative coma/delirium in this unique patient population.

Prophylaxis against venous thromboembolism in thoracic surgery patients: Lack of guidelines or inappropriate implementation?

BackgroundVenous thromboembolism (VTE) remains a fatal and preventable event for post-surgical patients. Many guidelines for prophylaxis were proposed for prevention. The aim of this project was to ensure that appropriate methods of VTE prophylaxis were implemented according to the NICE guidelines in a tertiary thoracic surgery unit. MethodsEighty patients who underwent thoracic surgery interventions in a tertiary thoracic surgery unit were included in the study which was carried out on two stages between October 2014 and July 2015. After studying the first forty patients, a risk assessment form was designed to assure proper implementation of the NICE guidelines for VTE prophylaxis and the study was then repeated on further 40 patients. ResultsThere was no difference in both groups regarding age and sex. The risk assessment form resulted in an improvement in VTE prophylaxis by applying thromboembolic deterrent stockings (TEDS) before and after operations (p < 0.001, p = 0.04), administration of Low Molecular Weight Heparin (LMWH) before and after the operation (p = 0.005, p = 0.04) and patient assessment for risk of VTE before surgery (p = 0.006). ConclusionsIn patients undergoing elective thoracic surgery, implementation of the risk assessment form is affordable, and is highly effective in preventing deep vein thrombosis (DVT) and possibly pulmonary embolism (PE) as it is used for follow-up of anti-thrombotic prophylactic protocols’ application. Information about VTE given to patients before surgery and on discharge still needs improvement. Further work should be done on our health systems if this potentially fatal and unsuspected condition is to become totally preventable.

PP33 - Lung abscess isolation using double lumen tubes combined with bronchial blockers: a case series

Thoracic surgery in patients with lung infections is an absolute indication to isolate healthy lung or lobes. Different methods have been described, including the double-lumen endotracheal tube (DLT) or a variety of bronchial blockers (BBs) (1). However, when an abscess is present in only one lobe and lobectomy is planned, the insertion of a DLT alone or a single tube plus a BB may not be sufficient to prevent the spread of infection to an ipsilateral lobe. We present three cases with lung infection in which the isolation was made by combining DLT with a BB. Case 1: 22-years-old man diagnosed with lung aspergilloma within the residual tuberculous cavity in the upper left lobe. The surgeon requested selective resection of this lobe. Case 2: 50-year-old man diagnosed with lung abscess in the left lower lobe with suspected neoplasia, proposed to lobectomy. Case 3: 45-year-old woman diagnosed with lung abscess in the left upper lobe with suspected neoplasia/infection, proposed for lobectomy. In all three cases, airway management was a combination of left DLT (two Robertshaw type DL and one VivaSight DL®) with a BB, using the flexible fiberoptic scope as a guide to place the BB to the lobe that was being isolated. In case 1 a Cohen BB was used; in case 2 and 3, an Arndt BB was chosen. After BB placement, the corresponding lobes were isolated, ventilation in the rest of the ipsilateral lung was initiated. The lobes remained isolated until the bronchus resection. In thoracic anaesthesia providing satisfactory surgical exposure and maintaining adequate oxygenation is a challenge. But in these cases, isolation was even more important. Several devices are used to perform lung/lobe isolation: some experts recommend DLT for its shorter insertion time and less need for repositioning; others suggest that the BB have lower complication rates with the same efficiency (2). However, in thoracic surgery involving lung abscess the combination of both devices (DLT and BB) provides excellent isolation and results. This method prevented the spread of infection to the healthy lung with the DLT and to non-affected areas of the ipsilateral lung with the BB during airway and surgical manipulation with a favourable clinical-surgical outcome. 1. Narayanaswamy M, et al. Choosing a lung isolation device for thoracic surgery: a randomized trial of three bronchial blockers versus double lumen tubes. Anest Analg 2009; 108(4):1097-101. 2. Clayton-Smith A, et al. A comparison of the efficacy and adverse effects of double lumen endobronchial tubes and bronchial blockers in thoracic surgery: A systematic review and meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth 2015; 29(4):955-66.

Pain-Related Limitations in Daily Activities Following Thoracic Surgery in a United States Population

Background: Ringsted et al created a statistically validated questionnaire to assess painrelated limitations in daily activities following thoracic surgery and translated it to English. We utilized the questionnaire to assess the impact of pain impairing certain daily activities in a United States thoracic surgery population. Objectives: Examine if the questionnaire developed and translated to English by Ringsted et al to assess the effects of chronic pain after thoracic surgery on daily activities would be applicable in a sample of thoracic surgery patients in the United States. Study Design: Cross-sectional study by mailed questionnaire. Setting: All patients who had thoracic surgery between 6 months and 3 years ago at a university hospital. Methods: We sent questionnaires to patients who had undergone thoracic surgery between 6 months and 3 years ago, yielding a sample of 349 eligible patients. Questionnaire results were statistically assessed for item fit, dimensionality, and internal reliability. Results: The response rate was 26.4%. Of the responders, 36% (95% CI: 26.1% to 46.5%) identified themselves as having chronic pain related to their thoracic surgery. Activities such as lying on the operated side, coughing, and carrying groceries were impaired in more than 50% of the patients who had thoracic surgery related pain (P &lt; 0.05). Patients with chronic pain were more likely to report pain in other body locations. Few activities were limited in the patients identifying themselves as not having chronic pain. Statistical measures indicate high internal reliability. Limitations: This was a retrospective questionnaire with 26.4% response rate. Conclusions: Pain continues to impair the daily activities of a significant proportion of patients after thoracic surgery in a sample from the United States. Despite cultural differences, the Danish procedure-specific questionnaire provides an applicable and similar assessment of functional impairment after thoracic surgery in American patients. Key words: Thoracic surgery, chronic pain, impairment, daily life, questionnaire

A Prospective Comparison of Intraluminal and Extraluminal Placement of the 9-French Arndt Bronchial Blocker in Adult Thoracic Surgery Patients

To compare the standard intraluminal approach with the placement of the 9-French Arndt endobronchial blocker with an extraluminal approach by measuring the time to positioning and other relevant intraoperative and postoperative parameters. A prospective, randomized, controlled trial. University hospital. The study comprised 41 patients (20 intraluminal, 21 extraluminal) undergoing thoracic surgery. Placement of a 9-French Arndt bronchial blocker either intraluminally or extraluminally. Comparisons between the 2 groups included the following: (1) time for initial placement, (2) quality of isolation at 1-hour intervals during one-lung ventilation, (3) number of repositionings during one-lung ventilation, and (4) presence or absence of a sore throat on postoperative days 1 and 2 and, if present, its severity. Median time to placement (min:sec) in the extraluminal group was statistically faster at 2:42 compared with 6:24 in the intraluminal group (p < 0.05). Overall quality of isolation was similar between groups, even though a significant number of blockers in both groups required repositioning (extraluminal 47%, intraluminal 40%, p > 0.05), and 1 blocker ultimately had to be replaced intraoperatively. No differences in the incidence or severity of sore throat postoperatively were observed. A statistically significant reduction in time to placement using the extraluminal approach without any differences in the rate of postoperative sore throat was observed. Whether placed intraluminally or extraluminally, a significant percentage of Arndt endobronchial blockers required at least one intraoperative repositioning.

Video-Assisted Thoracic Surgery in Patients With Previous Sternotomy and Cardiac Surgery.

Although video-assisted thoracic surgery (VATS) lobectomy has become a standard approach for early-stage 1 lung cancer, concerns exist regarding potential damage to the heart or bypass grafts when VATS is performed after cardiac surgery via median sternotomy. We could find only case reports regarding VATS lobectomy after sternotomy for cardiac surgery. Therefore, we reviewed our series of patients who underwent VATS anatomic resections after sternotomy for cardiac surgery. Between 1996 and 2010, there were 87 patients who underwent 88 pulmonary resections after sternotomy for coronary artery bypass grafting (64), valve replacement or repair (12), coronary artery bypass graft and valve replacement (6), and transplant (5). There were 10 women (11.5%) and 77 men (88.5%) with a mean age of 76.2 years. Diagnoses included lung cancer (83), pulmonary metastases (4), and benign disease (1). Dense adhesions between the lung and the mediastinum sometimes occur after cardiac surgery. Compared with the total series of 2684 VATS lobectomies, operations after sternotomy are associated with greater mortality (12, 0.4% vs 5, 5.7%), myocardial infarction (13, 0.5% vs 2, 2.3%), transfusion (45, 1.7% vs 12, 13.6), conversion to thoracotomy (188, 7% vs 14, 15.9%). Injury occurred to the left main pulmonary artery (1, 1%) and internal mammary artery graft (1, 1%). There were no intraoperative deaths. Previous sternotomy for cardiac surgery does increase the risk for VATS lobectomy. Conversion to thoracotomy should be considered if dense adhesions are found. Techniques to reduce the risk for the heart are discussed.

Video-Assisted Thoracic Surgery in Patients with Previous Sternotomy and Cardiac Surgery

Video-Assisted Thoracic Surgery in Patients with Previous Sternotomy and Cardiac Surgery

Postoperative Atrial Fibrillation Prophylaxis and Lung Resection – Our Experience with 608 Consecutive Patients

Postoperative atrial fibrillation is a common complication after lung resection. It is burdened by increased mortality and morbidity, prolonged hospitalization, and higher resource utilization in thoracic surgery patients. Therefore, some kind of pharmacological prophylaxis is recommended. In our patients, diltiazem, a calcium antagonist, is administered. We collected data on all 608 patients having undergone lung resection (no less than lobectomy) between November 2012 and May 2015. This period included patients having received diltiazem during their postoperative stay in our Intensive Care Unit and surgical ward, and those that did not receive it. Patients having had atrial fibrillation before the surgery and patients with cardiac pacemaker were excluded from the trial. Other patients were divided into three groups: patients with some kind of antiarrhythmic therapy before and continued after the surgery; patients with diltiazem prophylaxis; and patients without any antiarrhythmic prophylaxis. The data collected were statistically analyzed. We found no statistically significant difference in the incidence of postoperative atrial fibrillation among the groups (p<0.05).

NU02.02 Preoperative Thoracic Surgery Patient Education Program Development

NU02.02 Preoperative Thoracic Surgery Patient Education Program Development

A Multi-Objective Ensemble Method for Class Imbalance Learning

This article describes how class imbalance learning has attracted great attention in recent years as many real world domain applications suffer from this problem. Imbalanced class distribution occurs when the number of training examples for one class far surpasses the training examples of the other class often the one that is of more interest. This problem may produce an important deterioration of the classifier performance, in particular with patterns belonging to the less represented classes. Toward this end, the authors developed a hybrid model to address the class imbalance learning with focus on binary class problems. This model combines benefits of the ensemble classifiers with a multi objective feature selection technique to achieve higher classification performance. The authors' model also proposes non-dominated sets of features. Then they evaluate the performance of the proposed model by comparing its results with notable algorithms for solving imbalanced data problem. Finally, the authors utilize the proposed model in medical domain of predicting life expectancy in post-operative of thoracic surgery patients.

P2.06-040 WINNERS Study: Does a Formal Interactive Patient Education Program Positively Impact Patient Outcomes and Satisfaction after Thoracic Surgery: Topic: LAB, Other

Post-operative complications in the thoracic surgery patient population can be costly to healthcare systems and devastating to patients and their families. The most common complications are respiratory, cardiac and gastrointestinal in nature. It is estimated that these complications occur at a rate of 3-5%. In an effort to improve patient outcomes, a nurse led multidisciplinary team developed and implemented the WINNERS Study (Walking with INtegrated Nursing, Exercise, Respiratory/Rehab Services), designed to determine if a formal pre-operative/perioperative interactive patient education program would positively impact patient outcomes and improve satisfaction following thoracic surgery. All general thoracic surgery patients undergo informed consent and are randomized to current standard of care verbal pre-operative teaching vs pre-operative/perioperative interactive patient education program. The multidisciplinary team developed formal patient educational materials, written and audiovisual, used to educate and prepare patients for what they should expect post-operatively with respect to the importance of secretion management, ambulation, general aspects of what to expect after surgery and the importance of their active participation in their post-operative recovery. The study design is outlined in Figure 1. The endpoints include length of stay, reintubation rates, pneumonia incidence, quality of life measurements, physical function measurements (PFT / 6min walk / total steps). Patient satisfaction is measures with the Quality of Life Instrument, SF-36 at pre-determined time-points. Patients are currently actively enrolling into the study without any recruitment issues or adverse events.The preliminary analysis demonstrates a favorable impact on patient outcomes and improved patient satisfaction. This study is ongoing.

P2.06-041 TeleNursing: A Thoracic Surgery Nursing Initiative Aimed at Decreasing Hospital Readmissions and Increasing Patient Satisfaction: Topic: LAB, Other

In the USA there is a national initiative in healthcare to decrease hospital readmissions, decrease the cost of care while patients are hospitalized and to increase patient. A recent study evaluating mortality rates in the lung cancer resection patients reported a 30-day readmission was associated with a 6-fold increase in the 90-day mortality of this patient population (14.4% vs 2.5%). This report not only forces thoracic surgery teams to extend their operative mortality focus and reporting beyond the traditional 30-day time period but it also emphasizes the critical value and positive impact continued post-operative care for the first three months after discharge can have on patient outcomes. The expert care delivered by thoracic surgery nurses plays a critical role in decreasing post-operative complications and ensuring patients are safely discharged from the hospital. The valuable impact thoracic surgery nurses have on preventing hospital readmissions and improving patient satisfaction is the intended focus of this clinical trial. The positive impact telehealth interventions have on multiple different disease processes supports investigation of this care modality for the thoracic surgery patient population. We have designed a clinical trial focused on implementing a TeleNursing program with the specific aims of preventing hospital readmissions and improving patient satisfaction. Our thoracic surgery practice currently has a “day-after-discharge” follow-up phone call program that is directed by the thoracic surgery nurses in the practice. Pertinent clinical details of each patient’s post-operative course are relayed to the thoracic surgery nurses. The nurses call patients 2-3 days after discharge and asked questions related to medications, pain management, sign or symptoms of infection, activity level and expectations, sleep, appetite and general understanding of all discharge instructions. This interaction is documented in the electronic medical record. This program has been expanded to compare the efficacy of the phone calls vs scheduled video-calls between nurses and patients. Patients are randomized to standard of care day after discharge phone calls vs the TeleNursing follow-up video-call; discharge day 2, 1-month, 2-month and 3-month. All patients complete a patient satisfaction questionnaire at predetermined time points. The primary objective is to decrease hospital readmission rates and the secondary objective is to improve patient satisfaction. Although the results of this clinical trial are pending, interim analysis indicates that patients are willing to participate in this program and are pleased with the nurse-patient interaction beyond their hospital stay. This clinical investigation is ongoing.