[Early discharge following major thoracic surgery: identification of related factors]

There is a direct relation between hospital costs and hospital length of stay after the operation. In the other hand, reduced stay increases the productivity of the public hospitals with high service demanding. The objective of this study was to identify factors determining the decrease in hospital stay after major thoracic surgery. A two-phase retrospective study was conducted on analysis of medical records. In the first phase, data on length of hospital stay and related factors were collected from a consecutive series of 169 patients divided into group I (n=81)--patients operated on between June 1990 and 1995, and group II (n=88)--1996 through May 2000. In the second phase, data were collected from a consecutive series of 20 patients (group III) starting backwards from March 2002, for analysis and comparison with a internet survey sent to 21 thoracic surgeons. Intensive care unit was avoided for most patients in the immediate post operative period. The mean hospital stay decreased from 7.6 days (median 7) in group I to 5.1 days (median 4) in group II (p<0.001). The more frequent utilization of epidural analgesia and less traumatic thoracotomy in group II reached statistic significance (p<0.001). In group III, the mean hospital stay was 4.2 days (median 4), and there was a more effective use of epidural analgesia (75%) and muscle-sparing thoracotomy (90%). Eight thoracic surgeons answered the survey: the mean hospital stay varied from 5 to 9 days and all patients were sent to intensive care or similar units. Only two surgeons utilize muscle-sparing thoracotomy. This study confirms that pain control and less traumatic surgical approach are important for faster functional recovery of the patients. It suggests that the IC units may be used only for selected patients.