Ara Klijian, MD
Chairman, Cardiothoracic Surgery
Sharp & Scripps
San Diego, California
Disclosure information not submitted.
Kaveh Bagheri, MD, Attending Pulmonologist & Critical Care Intensivist
Medical Director, Sharp Grossmont Lung Clinic
Sharp Grossmont Hospital
La Mesa, California, United States
Disclosure information not submitted.
Title: Awake Video Assisted Thoracic Surgery (AVATS) to Stream Line Pulmonary Care and Optimize Outcomes
INTRODUCTION/HYPOTHESIS:
AVATS, Awake Video Assisted Thoracic Surgery, under local anesthesia with sedation has been used in a variety of cases. We analyzed the effects on post-op care and outcomes.
Methods:
We performed over 2300 AVATS for benign/malignant conditions, often via single incision in patients with extremely poor pulmonary reserve. Procedures included lobe/segmentectomy, decortication, pleurodesis, pericardial window, bullectomy, BP fistula/diaphragm/chyle duct/esophageal repairs without significant morbidity or mortality. Peri-op line usage, chest tube drainage, morbidity/mortality were analyzed.
Results:
All cases were performed without central venous/epidural catheters or spinal anesthetics. Only 24 required arterial catheters and 12 Foley catheters. Pre-op co-morbidities included hypertension (1312,) CAD (822- 280 of these s/p CABG,) DM (910,) COPD (680,) tobacco use (1606,) atrial fibrillation (121), renal disease (212- 58 requiring dialysis,) hepatic disease (49,) prior stroke (15). Patients were followed for 2 years and morbidity/mortality data obtained. No deaths were seen. The average length of stay for lobectomy was 1.2 days. Sixty cases of atrial fibrillation were seen (all managed medically,) one IV site phlebitis treated by removal of IV. The use of dexmedetomidine allowed intra-op evaluation of air leak, thus enabling control prior to removal of the thoracoscope. Only 8 required greater than 2 days of post-op chest tube drainage (4 patient required 2-day drainage and 4 patients required 3-day drainage.) Average chest tube removal was 23 hours. Performing these cases through single small incisions, reduced post-op pain/ narcotics. All received a combination of peri-/post-op iv acetaminophen, and ketorolac, if renal status allowed, minimizing nausea, negative effects on respiratory drive, and prevented altered sensorium. Ten re-admissions, all due to unrelated issues (5 for exacerbation of CHF, 4 for non-thoracic elective procedures and 1 for control of diabetes.). There was no stroke, UTI, DVT/PE, acute/delayed pneumothorax, arterial/central line infections, or pneumonia/nosocomial infections.
Conclusions:
AVATS, often in patients previously deemed inoperable, simplified peri-op care, reduced length of stay, and improved patient satisfaction without added morbidity/mortality.