Hubert Julien, Bourdages-Pageau Etienne, Garneau Charles Antoine Paradis, Labbé Catherine, Ugalde Paula A
Departments of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.
J Thorac Dis. 2018 Mar;10(Suppl 4):S583-S590. doi: 10.21037/jtd.2018.01.156.
Canada has a universal public health system where all resources must be allocated to optimize cost-effectiveness. Rapid diagnostic assessment programs (DAPs) and enhanced recovery protocols (ERPs) may improve timeliness of care and postoperative outcomes and thus reduce costs. The use of DAPs and ERPs in lung cancer patients who undergo lobectomy via video-assisted thoracoscopic surgery (VATS) is still controversial. This study measured the time between preoperative workup and treatment with a DAP and evaluated the impact of an ERP postoperatively in patients with early-stage non-small cell lung cancer (NSCLC) who received a VATS lobectomy.
We conducted a retrospective review of patients who underwent minimally invasive lobectomy for the primary treatment of lung cancer from January 2014 through May 2017 at our institution. Timelines of care were measured. Postoperatively, the duration of chest tube drainage, length of hospital stay, and incidence of complications were noted.
During the study period, 646 patients underwent VATS lobectomy for stage I or II NSCLC; of these, 384 (59%) were assessed within the DAP. Using the DAP, the median time between the patient's first clinic visit and referral to surgery was 30.0 days [interquartile range (IQR), 21.0-40.0 days), and the median time between surgical consult and treatment was 29.0 days (IQR, 15.0-47.5 days). With the ERP, the median duration of chest drainage was 3.0 days (IQR, 2.0-6.0 days), and median hospital stay was 4.0 days (IQR, 3.0-7.0 days).
DAPs and ERPs have promising roles in thoracic surgical practice. A rapid DAP can expedite the care trajectory of patients with lung cancer and has allowed our institution to adhere to governmental standards for the management of lung cancer. ERPs are feasible to establish and can effectively improve clinical outcomes.
加拿大拥有全民公共卫生系统，在该系统中，所有资源都必须进行分配以优化成本效益。快速诊断评估项目（DAPs）和强化康复方案（ERPs）可能会改善护理及时性和术后结果，从而降低成本。在接受电视辅助胸腔镜手术（VATS）肺叶切除术的肺癌患者中使用DAPs和ERPs仍存在争议。本研究测量了术前检查与采用DAP治疗之间的时间，并评估了ERP对接受VATS肺叶切除术的早期非小细胞肺癌（NSCLC）患者术后的影响。
我们对2014年1月至2017年5月在本机构接受微创肺叶切除术作为肺癌主要治疗方法的患者进行了回顾性研究。测量了护理时间线。术后记录胸腔引流管留置时间、住院时间和并发症发生率。
在研究期间，646例患者接受了I期或II期NSCLC的VATS肺叶切除术；其中，384例（59%）在DAP内接受了评估。采用DAP时，患者首次门诊就诊至转诊手术的中位时间为30.0天[四分位间距（IQR），21.0 - 40.0天]，手术会诊至治疗的中位时间为29.0天（IQR，15.0 - 47.5天）。采用ERP时，胸腔引流的中位时间为3.0天（IQR，2.0 - 6.0天），中位住院时间为4.0天（IQR，3.0 - 7.0天）。
DAPs和ERPs在胸外科实践中具有重要作用。快速DAP可以加快肺癌患者的护理进程，并使我们的机构能够遵守政府的肺癌管理标准。ERPs易于建立且能有效改善临床结果。
