Early discharge after lung surgery benefits patients without increasing risk of readmission

When hospitals implement programs to optimize patient recovery after surgery, health care costs decline and patients achieve better results. One of the major benefits of the programs, known as improved recovery routes, includes shorter stays at the hospital. But thoracic surgeons are often reluctant to discharge a patient in a timely manner for fear that early discharge will harm their patients and not lead to early readmission.

Now, Nathaniel Evans III, MD, director of the Division of Thoracic and Oesophageal Surgery at Jefferson Health, and his colleagues examined the hypothesis and showed that early exit did not increase the risk of readmission of patients after minimally invasive lung surgery. The discovery indicates that early exit is a safe practice for facilities with well-established improved recovery routes. Dr. Evans and his team published the research in the journal Innovations: technologies and techniques in cardiothoracic and vascular surgery online before print on March 14th.

Enhanced recovery pathways are a set of protocols used by surgical teams before, during and after surgery to provide the best possible care for patients. In Jefferson's well-defined ERP, doctors educate patients with lung surgery on the benefits of quitting before the procedure. During the operation, surgeons use minimally invasive techniques and closely monitor patients' fluids. After the procedure, specially trained nurses to treat patients who have undergone thoracic surgery closely monitor any changes in their condition. Doctors also minimize the use of opioids and other narcotics, while encouraging patients to eat regularly and get back on their feet as soon as they are able to. The combination of interventions stimulates the recovery of patients.

Dr. Evans and his colleagues badyzed the readmission rates of nearly 300 patients who underwent lung resection in Jefferson between January 2010 and July 2017. On average, patients stayed in the hospital for three to five days after the surgery. patients have returned home in one or two days. The investigators matched the "mean" and "early" groups according to symptoms, stage of illness, and other factors, to allow an apple-to-apple comparison. Still, Dr. Evans and his team found that hospital readmission rates were lower in patients released earlier, one to two days after the operation.

"Patients and their doctors are often afraid to go home too soon, which will probably make them return to the hospital," says Dr. Evans. In fact, the opposite is true. Patients who are well enough to go home, who no longer need hospital services, are very unlikely to need to return, "

Longer stays at the hospital were also badociated with higher complication rates. Thirty percent of patients who stayed in the hospital for an average length of time suffered from complications, compared to only 7% of patients who left the hospital earlier, report Dr. Evans and colleagues.

"The goal of improving recovery pathways is to enable healthy patients to return home sooner and to ensure that the sickest patients receive the care they need," says Dr. Evans. . "As could be expected, patients who were not ready for their early discharge were more likely to be sicker patients and who, we know, are at a higher risk of complications and readmissions. "

Overall, the risk of readmission was 2.3 times higher for hospitalized patients three to five days after surgery than for patients on early discharge. The results show that in institutions with well-defined enhanced recovery pathways, early discharge does not increase the risk of readmission for thoracic surgery patients and may actually reduce the number of readmissions and improve outcomes. results for patients.

Provided by
Thomas Jefferson University