Posted on September 12, 2001 at 10:54 a.m.

BIRMINGHAM, AL — Strict daily guidelines of care for those who undergo lung surgery can significantly reduce a patient’s length of stay in the hospital and actually increase quality of care and patient satisfaction. Results of a study done by a UAB (University of Alabama at Birmingham) chest surgeon were reported in the August issue of the Journal of Thoracic and Cardiovascular Surgery.

In the study, lead author Robert Cerfolio, M.D., outlines a very specific daily treatment and management regimen for patients who undergo a broad range of lung surgeries. The regimen allows most patients to go home within three to four days, compared to the national average of six to seven days stay following these types of surgeries.

Cerfolio is acknowledged as one of the busiest lung surgeons in the world, performing a volume of around 800 operations a year.

By following the procedures outlined, patients can be taken off breathing machines immediately after the operation, proceed directly to their room and avoid the intensive care unit. They are generally discharged within three to four days, and have minimal risks with high satisfaction both at discharge and at a two-week follow-up.

“Concerns about cost containment, third-party payers and health maintenance organizations have changed how physicians have practiced over the past 10 years. Despite these external influences, our main goal as thoracic surgeons has remained the same. We still must perform safe operations, minimize morbidity and mortality and not compromise the quality of our care or patient satisfaction,” Cerfolio said. “However, the reality is that we must achieve these goals in the context of a cost-conscious environment.”

Costs that stem from postoperative care are the easiest for doctors to adjust, Cerfolio says, since that cost is mostly affected by the patient’s length of stay in the hospital. By reducing a patient’s length of stay, lung surgeons can reduce costs without compromising the patient’s safety or satisfaction.

Of 500 patients in the study, 327 (65 percent) left the hospital on postoperative day 4 or sooner. Complications occurred in 107 (21 percent) patients, and operative mortality was 2 percent. Both numbers are below the national average. Most complications were minor (irregular heartbeats) and did not delay discharge. Many of these patients had complicated operations and 59 percent were elderly with multiple complex medical problems. Many patients were referred from physicians from other states and countries and 15 percent had been denied surgery by other surgeons. By survey, 97 percent of patients had excellent or good satisfaction with their care at hospital discharge, and 91 percent were extremely happy or satisfied at the 2-week follow-up contact.

Cerfolio said the key to successful implementation of his guidelines is continuous review of the planned events of each day. “This allows patients’ and families’ expectations to be met,” he said. “We know that communication with our patients and their families is crucial to maintain high patient satisfaction.”

Cerfolio said the study demonstrates that “sometimes the way things have always been done is not always the best.

“Many of the procedures we use to treat patients following surgery have been passed down from generation to generation,” he said. “It is imperative that we continue to study these methods and as surgeons, we must continue to strive for cost-saving measures that maximize safety, quality of care and satisfaction.”