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Patient education, Pre-Operative Optimization

What is Fast Track Thoracic Surgery?

Today we are taking about one of my favorite topics, Fast Track Thoracic Surgery –  which is a fancy name for trying to streamline the surgical experience to prevent complications and shorten the time to discharge.  It’s an on-going process, and many of the things that were once just ideas “What if we extubated people in the operating room?” are now standard practice.   But ten years ago, most people stayed intubated and on the ventilator overnight after surgery..

A lot of the techniques mentioned in the literature that we’ve included (links) here is now the current standard of treatment,(and these articles are just a few years old – which shows how quickly things can change) such as:
– VATS procedures versus open surgery,
– early extubation in the operating room,
and the one we are going to focus on,
early mobilization (that’s walking, in plain English) but since all of this ‘early mobilization’ (or getting out of bed and walking right as early after surgery as possible) falls on you, the patient – it’s important that we explain why we are asking you to do all these things that are the absolutely the last thing you want to do after you’ve been operated on..

We’ve already discussed this another article, but since ‘early mobilization’ is one of those things that absolutely, truly makes a huge difference, but so often get missed; because the patient doesn’t feel receptive to the idea after surgery, the surgeon doesn’t mention it during his visits, and the nurses are too busy to encourage you (because it means more work for them anyway) – so we are going to revisit the concept.

So, you want me to get out of bed and walk around, just after surgery?  But I am tired, sore, and I have all this stuff (IVs, chest tubes, urinary catheter) attached to me..

I know, I know – I wouldn’t want to do it either – but wanting to – and finding the strength and motivation to do it even when you really don’t want to – are two different things..  And you should know by now, I absolutely wouldn’t ask you to do it, if it wasn’t critically important.

But these low-tech things*, such as walking, and using an incentive spirometry really do make a huge difference – and yes, in some cases, a difference between life and death (from respiratory complications, etc.).  So not only do I want you to walk – I want to you do it a couple times a day – at least three, and I want you to enlist your friends and family to help.  (If I were there, I would be coming by to help you untangle all the equipment, make sure your behind is covered in your robe, and push your IV pole, while we chatted about other stuff – but in all likelihood – I’m not going to be there, so we better just get you moving anyway.)

And I want you to keep going – keep walking, even after discharge, when you get home.  Don’t plop down on the couch or bed with the remote – keep doing all the walking, coughing/ deep breathing exercises, and using your incentive spirometer..  Keep it up until you see your doctor at your follow up appointment..

At that appointment – particularly if you had a lobectomy, or a large piece of lung taken out – be sure to ask him about a prescription of pulmonary rehabilitation, if you didn’t get one a few weeks before surgery, or when you were discharged from the hospital.

* I had a couple of patients in the past who expressed surprise that things like walking, not computer-based technology were the main driving force between rapid recovery and the development of complications.  “There’s not some machine to do this?”
“Nope, just those legs you were born with..”

I’m not making fun, it’s just that it sounds far too simple for people to believe..which is why even though it sounds so obvious to you here, it’s one of the things I have to go over with people several times before and after surgery.
But, really, it is that simple.. Get up and walk like your life depended on it.  It does.

Now in some of these articles, ambulation and pre-operative management get just a passing mention;- but remember, these articles are written by surgeons, not nurses.. They’d rather talk about surgery, not ‘physiotherapy’.  But even so, they do take time to mention it – because it is important..

I’ll be updating this article with new references every so often.

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About K Eckland

World of Thoracic Surgery is a blog about the work, research, and practices of thoracic surgeons around the world. It includes case studies, [sometimes] dry research, interviews with thoracic surgeons along with patient perspectives, and feedback.

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