Vigneswaran Wickii T, Bhorade Sangeeta, Wolfe Mary, Pelletiere Karen, Garrity Edward R
Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
Int Surg. 2007 Mar-Apr;92(2):93-8.
Transplant programs are under pressure to resolve multiple challenges related to quality, cost, and access in a resource-driven customer-focused health care environment. We reviewed outcomes of patients undergoing isolated lung transplantation using a single postoperative clinical pathway, developed between the specialties of Thoracic Surgery, Pulmonary and Critical Care Medicine, and Nursing. The data were retrospectively reviewed for mortality, length to extubation (LE), hospital length of stay (LOS), and readmissions of 183 consecutive patients. One hundred ten women and 73 men with a mean age of 48 +/- 12 years underwent 90 bilateral, 88 single, and 6 repeat lung transplantations. Median LE was 17 hours, and the LOS was 7 days. The operative mortality was 6.5%. One- and 3-year survivals were 82% and 73%, respectively. We conclude that a single multidisciplinary clinical pathway can facilitate early discharge from the hospital. Early hospital discharge after lung transplantation does not compromise early or late outcome.
在资源驱动且以客户为中心的医疗保健环境中，移植项目面临着应对与质量、成本和可及性相关的多重挑战的压力。我们回顾了采用单一术后临床路径的孤立肺移植患者的结局，该路径由胸外科、肺与重症医学以及护理专业共同制定。对183例连续患者的死亡率、拔管时间（LE）、住院时间（LOS）和再入院情况进行了回顾性数据审查。110名女性和73名男性，平均年龄48±12岁，接受了90例双侧、88例单侧和6例重复肺移植。中位LE为17小时，LOS为7天。手术死亡率为6.5%。1年和3年生存率分别为82%和73%。我们得出结论，单一的多学科临床路径可促进早期出院。肺移植后早期出院并不影响早期或晚期结局。
