Four Hours Postoperative Mobilization is Feasible After Thoracoscopic Anatomical Pulmonary Resection
- PDF / 369,717 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 96 Downloads / 143 Views
ORIGINAL SCIENTIFIC REPORT
Four Hours Postoperative Mobilization is Feasible After Thoracoscopic Anatomical Pulmonary Resection Takeo Nakada1 • Suguru Shirai1 • Yuko Oya1 • Yusuke Takahashi1 • Noriaki Sakakura1 Takashi Ohtsuka2 • Hiroaki Kuroda1
•
Accepted: 11 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background We aimed to analyze the feasibility and risk factors associated with early mobilization (EM) within 4 h after thoracoscopic lobectomy and segmentectomy. Methods This study retrospectively evaluated 214 consecutive patients who underwent thoracoscopic anatomical pulmonary resection using our EM protocol between October 2017 and February 2019. We compared the correlations of the patients’ characteristics including the total number of drugs and perioperative parameters such as air leak, and orthostatic hypotension (OH) between the EM (E group) and failed EM (F group) groups. Second, we evaluated risk factors for OH, which often causes critical complications. Results A total of 198 patients (92.5%: E group) completed the EM protocol, whereas 16 patients did not (7.5%: F group). The primary causes of failure were severe pain, air leak, postoperative nausea and vomiting, and OH (n = 1, 3, 8, and 4). Upon univariate analysis, air leakage, OH, and non-hypertension were identified as risk factors for failed EM (all p \0.05). EM was associated with a shortened chest tube drainage period (p \0.01). Thirty patients (14%) experienced OH, and 20% of them failed EM. A total number of drugs C5 (p = 0.015) was an independent risk factor for OH. Operative and anesthetic variables were not associated with EM or OH. Conclusions The EM protocol was safe and useful for tubeless management. Surgeons should be advised to actively prevent air leak. Our EM protocol achieved a low frequency of OH in mobilization. Due to its versatility, our mobilization protocol may be promising, especially in patients without severe comorbidities. Clinical registration number: The study protocol was approved by the Review Board of Aichi Cancer Center (approval number: 2020-1-067).
Introduction
& Takeo Nakada [email protected] 1
Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
2
Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, Nishishinbashi 3-19-18, Minatoku, Tokyo 105-8471, Japan
Enhanced recovery programs (ERPs) for pulmonary resection contribute to good surgical outcomes, such as reducing complications, shortening hospital stay, and saving medical costs [1–4]. However, all components of an ERP may not be necessary for video-assisted thoracoscopic surgery (VATS) pulmonary resection [5]. Most patients are mobilized on postoperative day 1, and chest drains are removed when the drain output in a 24-h period is \300–400 mL and there is no air leakage [1–7]. Early chest tube removal is frequently associated with not only a
123
World J Surg
shortened length of postoperative hospital stay but also a reduc
Data Loading...
