How we decide when to immobilize the wrist after stable osteosynthesis of displaced distal radius fracture

PURPOSE OF THE STUDY

 Fractures of the distal radius are frequently associated with injuries of the scapholunate (SL) and lunotriquetral (LT) ligaments. Our study is aimed at revealing their hidden lesions by employing a fast and accessible fluoroscopic identification.

PATIENTS AND METHODS

 We investigated 40 patients who were indicated for plate osteosynthesis of distal radius fracture. After completing the osteosynthesis, the procedure was concluded with a wrist arthrography. The patients with SL and LT interval lesions had their wrists immobilized by a plaster splint while patients with normal findings with an elastic bandage. The patients were followed up for 12 months after the surgery. The functional results were evaluated by Mayo wrist score.

RESULTS

The intra-operative examination identified 62.5 % of patients with lesions of SL and/or LT interval, and 37.5 % of patients were lesion-free. The Mayo wrist scores after 3, 6 and 12 months in patients whose wrists were not immobilized were 72, 86.3, and 86.3, respectively. The latter scores in the group of patients with external immobilization were 54.4, 82, and 84.8, respectively. The difference between the groups was significant three months after the surgery. After six and twelve months, the difference became negligible.

CONCLUSION

 The exclusion of hidden lesions allows earlier rehabilitation, while in patients with signs of lesions, it is appropriate to immobilize the wrist (Tab. 1, Fig. 3, Ref. 31). Text in PDF www.elis.sk Keywords: distal radius fractures, scapholunate ligament, lunotriquetral ligament, fluoroscopic, diagnosis.

OS06.4A Identification of T cell receptors targeting ZFTA-RELA fusion-positive ependymoma

BACKGROUND

The oncogenic gene fusion between ZFTA (formerly C11orf95) and RELA has in recent years been highlighted as oncogenic driver event ultimately leading to malignant transformation and progression of ependymoma. Representing a genetic hallmark in 17.6% of ependymomas, ZFTA-RELA fusion-positive tumors qualified as separate diagnostic entity in the 2016 revision of the WHO classification of CNS tumors. This tumor entity mainly occurs in pediatric patients and is characterized by poor prognosis and the lack of biology-driven therapy.

RESULTS

De novo prediction of putative gene fusion-derived neoepitopes in malignant CNS diseases yielded several potential candidates suitable for screening. Of these, vaccination of A2.DR1-transgenic major histocompatibility complex (MHC)-humanized mice with in silico compiled peptide vaccines encompassing the ZFTA-RELA fusion sequence elicited robust antigen-specific CD4+-restricted immune responses. We identified ZFTA-RELA-reactive T cell clones by multiplexed Interferon-γ / Interleukin-2 recall response. Single-cell VDJ-sequencing of reactive T cells demonstrated a highly clonal T cell receptor (TCR) repertoire and shared clonotypes among all vaccinated animals. Matching TCRα/β chains have been assembled from single-cell sequencing data and cloned for functional testing of neoepitope-reactive TCR-transgenic T cells in vitro as well as in vivo using a transposon system-based immunocompetent, MHC-humanized ZFTA-RELA fusion-positive ependymoma model.

CONCLUSION

Here we identify the oncogenic ZFTA-RELA gene fusion product as a novel tumor-specific neoepitope that is recognized by MHC class II-restricted TCRs. Therapeutic efficacy of TCR-transgenic cell therapy can be further investigated using an immunocompetent MHC-humanized mouse model of ZFTA-RELA fusion-positive ependymoma. Our findings provide initial evidence for neoepitope-specific immunotherapy in pediatric CNS tumors.

OS12.4.A MHC class II-restricted transgenic T cell receptor therapy targeting mutant capicua transcriptional repressor in experimental gliomas

BACKGROUND

Glioma subtypes are classified according to their characteristic mutations and show a high degree of resistance to standard therapeutic interventions such as radiotherapy and alkylating chemotherapy. Some of these characteristic mutations have shown to generate immunogenic neoepitopes that can be targeted with immunotherapy. 70% of oligodendrogliomas carry capicua transcriptional repressor (CIC) inactivating mutations.

RESULTS

In a screen for potential immunogenic glioma neoepitopes we identified recurrent CIC hotspot mutations at position 215 (CICR215W/Q) expressed in a subset of oligodendrogliomas as an immunogenic major histocompatibility complex (MHC) class II-restricted neoepitopes. Peptide-based vaccination of MHC-humanized mice resulted in the generation of robust mutation-specific T cell responses against CICR215W/Q, restricted to MHC class II. Droplet-based single cell T cell receptor (TCR) sequencing from CICR215W-specific T cell lines enabled retrieval of MHC class II-restricted CICR215W-reactive TCRs. By retroviral transduction of T cells, we established a flow cytometry-based testing platform of retrieved TCRs and were able to show the top reactive TCR against CICR215W to be shared between individual mice. Using a newly developed glioma model in MHC-humanized mice induced by CRISPR-based delivery of tumor suppressor targeting guide RNAs, we show that adoptive intraventricular transfer of CICR215W-specific TCR-transgenic T cells exert anti-tumor responses against CICR215W-expressing syngeneic gliomas.

CONCLUSION

The integration of immunocompetent MHC-humanized orthotopic glioma models in the discovery of shared immunogenic glioma neoepitopes facilitates the identification and preclinical testing of HLA-restricted neoepitope-specific TCRs for locoregional TCR-transgenic T cell adoptive therapy.

[Elective treatment of inguinal hernia in university surgery-an economic challenge]

INTRODUCTION

Elective and emergency inguinal hernia surgery is a central task for general and abdominal surgeons. As a standard procedure it is regarded as having a relatively low income in the German diagnosis-related groups (DRG) system. This can lead to an economic imbalance, especially in a cost-intensive environment of a university hospital. The aim of this analysis was to investigate the influence of clinical factors on costs and the contribution margin as well as the overall economic evaluation of elective inguinal hernia surgery at a university hospital.

MATERIAL AND METHODS

All patients undergoing elective inguinal hernia surgery at two locations of the Charité University Medicine Berlin in 2014 and 2015 were included in the analysis. The influence of clinical, patient and surgical factors on the economic outcome of the cases was evaluated.

RESULTS

A total of 419 patients were included, mostly after a Lichtenstein operation (44.9%) and laparoscopic transabdominal preperitoneal (TAPP) surgery (53.9%). The greatest impact on the economic outcome was the occurrence of postoperative complications. Also, a patient clinical complexity level (PCCL) value of >1, more than 8 encoded secondary diagnoses and a duration of hospital stay of less than 2 days had a significantly negative impact on the contribution margin. Overall, elective inguinal hernia surgery led to a negative contribution margin of € 651 per case.

CONCLUSION

Elective inguinal hernia surgery in the environment of a university hospital has a high financial deficit; however, since a complete discontinuation of this treatment is not an alternative multifactorial approaches are required to improve the economic outcome.

[Comparison of 2-Screw Implant and Antirotational Blade Implant in Treatment of Trochanteric Fractures]

PURPOSE OF THE STUDY Surgical treatment of trochanteric fractures with intramedullary nailing still remains controversial as to which nail design is the best with no postoperative complications. The purpose of this study was to provide a comparative evaluation of complications in the treatment of trochanteric fractures using 2-screw proximal femoral nail versus proximal femoral anti-rotational blade nail. MATERIAL AND METHODS A retrospective review was conducted between March 2013 and March 2019. The study included 519 patients (358 females and 161 males) treated surgically for trochanteric fractures. The mean age was 79.8±12.0 (24-100) years. A1.2 type of fracture occurred in 153 (29.5%) cases, A1.3 type in 155 (29.9%), A 2.2 type in 90 (17.4%), A2.3 type in 95 (18.3%), A3.1 type in 11 (2.1%), A3.2 type in 7 (1.3%) and A3.3 type in 8 (1.5%) cases. Patients were treated either by 2-screw nail PFN (393 patients (75.7%) or by anti-rotational blade nail PFNA (126 patients (24.3%). RESULTS Our primary objective was to evaluate the implant related complications (e.g. cut-out, back-out, irritation, peri-implant fractures). Other complications (infection) and revision surgeries were also recorded. Complications were observed in 38 (9.7%) patients with PFN nail and 7 (5.6 %) patients with PFNA blade nail (p = 0.15). Screw back-out (n = 11) and cut-out (n = 11) were the most frequent complications in patients treated by 2-screw PFN nail and occurred in 5.6%. In the PFNA group, cutout occurred in 1.6% (n = 2) of cases while no cases of back-out were reported. Infection (n=3) was the most common complication in the latter group and represented 2.4%. In the PFN group the infection rate was 2.3% (n = 9). There were no statistically significant differences between both the groups considering implant-related complications (p = 0.14) and infections (p = 1.0). Revision surgery was performed in 33 patients (66.7%). DISCUSSION Biomechanical studies of intramedullary nails suggest good results with minimal complications if a two-screw implant is used. When antirotational blade is used, compression of spongiosis around blade is observed, which increases stability, especially in an osteoporotic bone. In our study, complications in these two types of nails were retrospectively compared. Considered as the limitation of our study is the retrospective nature of evaluation, which made it impossible the create two study groups with equal or similar number of patients, to follow up the patients postoperatively for a long period of time and to evaluate fracture union and limb function. CONCLUSIONS In our study no statistically significant difference in postoperative mechanical and infectious complications was confirmed between the 2-screw proximal femoral nail and the proximal femoral nail with antirotational blade. We have arrived at the conclusion that both types of nails are equivalent in treating trochanteric fractures. Key words: intramedullary nail, screw, blade, trochanteric fracture, complication.

Perspectives of 3D printing technology in orthopaedic surgery

Using most widespread technology of rapid prototyping (RP) in medicine focus on the development of models for diagnosis, for training and planned surgery, as well as the direct manufacture of implants for bone reconstruction. The applications of 3D printing in the field of medicine are giving extraordinary results and tissue and prosthetic 3D printing, medical and engineering research professionals are conducting 3D printing organ bind. Researchers worldwide are pursuing the creation of artificial bone using 3D printers, bones that can be later implanted to humans. In near future, many body parts could be manufactured in a turn and successfully implanted to patients. Although medical advances in 3D printing are used in orthopaedic field, research in 4D printing has already started. Flat objects made with 3D printing, using a regular plastic, combined with smart material, were able to become a hub without an external intervention. In nutshell, the future of additive manufacturing (AM) in trauma and orthopedic surgery is relatively bright with the inclusion of 3D printing in medicine. Bioprinting in this area will be focused on fractures, nonunions, deformities and bone, cartilage and soft tissue reconstruction. CONCLUSION: The innovative technology not only assists the medical staff but is also beneficial for the patients because the medical problems, which were not curable in the past, are now possible with modern technology (Fig. 4, Ref. 52) Keywords: bone defect, tissue engineering, 3D printing, biomaterials, bone, porous scaffold.

What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

PURPOSE

This study aimed to specify the optimal lengths of the distal locking screws (in a female population undergoing distal radius fracture fixation with a volar locking plate) to avoid damaging the dorsal extensor tendon compartments while preserving stability.

METHODS

Twenty-five female adult patients underwent volar locking plate fixation with four 2.4 mm locking screws inserted distally. Our modified dorsal tangential fluoroscopic view (DTV) was taken perioperatively followed by postoperative CT scans to compare the accuracy in determining the distal screw lengths.

RESULTS

Our modified DTV was 88 %, 84 %, 88 %, and 76 % sensitive in detecting screw lengths in the first, second, third, and fourth distal plate holes, respectively. According to the CT scans, none of the screws were over-penetrated in the third dorsal compartment, over-penetration was found in the second and fourth dorsal compartment. The most-accurate screw lengths in the four most distal plate holes in female distal radius fracture are 14, 20, 20, and 20 mm from the radial to the ulnar aspect.

CONCLUSION

In dorsal cortex comminution, when perioperative measuring is imprecise, inserting the most-suitable distal locking screw for problematic hole and then applying our modified DTV seems to be a simpler and safer option (Tab. 3, Fig. 4, Ref. 33).

A comparison of laparoscopic and open repair of subxiphoid incisional hernias

INTRODUCTION

Incisional hernias to the subxiphoid region are rare and anatomically challenging, with bony and cartilaginous structures attaching, as well as conflating abdominal fascia. The repair of hernias in this region is, therefore, difficult and prone to recurrence. The surgical treatment can be done by open or laparoscopic repair but very little is known about which method is superior. We, therefore, reviewed our data of patients undergoing repair of subxiphoid hernias.

METHODS

Between January 2010 and June 2015 twenty-eight patients were treated by laparoscopic (n = 8) or open (n = 20) hernia repair due to an incisional hernia in the subxiphoid region. Patients with ventral hernias with an origin more distal than the M1-area only extending into the subxiphoid region and those undergoing suture hernia repair were excluded.

RESULTS

The hernia sizes, in terms of length, width and EHS classification, did not vary between open and laparoscopic repair. The duration of laparoscopic surgery was significantly shorter than the mean operative time for an open subxiphoid hernia repair (168.1 min vs. 96.1 min, respectively; p = 0.012). The groups did not differ significantly in terms of overall postoperative complications (p = 0.568) but the grade (Clavien-Dindo) of complications was higher following open repair leading to three reoperations. Within the follow-up time, we diagnosed significantly (p = 0.031) more subxiphoid hernia recurrences after laparoscopic repair (37.5%, n = 3) than after open repair (0%).

CONCLUSION

Laparoscopic and open repair of subxiphoid incisional hernias are both technically challenging compared to other midline hernias. Referring to our results laparoscopic repair has shorter operative times, lower postoperative morbidity with a higher recurrence rate compared to open repair but the sample size is too small for an overall conclusion.

A comparative study of Cutibacterium (Propionibacterium) acnes clones from acne patients and healthy controls

BACKGROUND

Cutibacterium (Propionibacterium) acnes is assumed to play an important role in the pathogenesis of acne.

OBJECTIVES

To examine if clones with distinct virulence properties are associated with acne.

METHODS

Multiple C. acnes isolates from follicles and surface skin of patients with moderate to severe acne and healthy controls were characterized by multilocus sequence typing. To determine if CC18 isolates from acne patients differ from those of controls in the possession of virulence genes or lack of genes conducive to a harmonious coexistence the full genomes of dominating CC18 follicular clones from six patients and five controls were sequenced.

RESULTS

Individuals carried one to ten clones simultaneously. The dominating C. acnes clones in follicles from acne patients were exclusively from the phylogenetic clade I-1a and all belonged to clonal complex CC18 with the exception of one patient dominated by the worldwide-disseminated and often antibiotic resistant clone ST3. The clonal composition of healthy follicles showed a more heterogeneous pattern with follicles dominated by clones representing the phylogenetic clades I-1a, I-1b, I-2 and II. Comparison of follicular CC18 gene contents, allelic versions of putative virulence genes and their promoter regions, and 54 variable-length intragenic and inter-genic homopolymeric tracts showed extensive conservation and no difference associated with the clinical origin of isolates.

CONCLUSIONS

The study supports that C. acnes strains from clonal complex CC18 and the often antibiotic resistant clone ST3 are associated with acne and suggests that susceptibility of the host rather than differences within these clones may determine the clinical outcome of colonization.

[Surgical versus non-surgical treatment for 3- and 4-part proximal humerus fractures]

INTRODUCTION

Proximal humerus fractures account for about 45% of all fractures. Treatment of 3- and 4-part fractures is difficult, and the optimal treatment option remains controversial. The aim of the study was to compare surgical and non-surgical treatments of 3- and 4-part fractures of the proximal humerus in adults.

METHOD

A prospective study of surgical and non-surgical treatments of 3- and 4-part fractures of the proximal humerus was conducted at the 2nd Department of Orthopedics and Traumatology, University Hospital Bratislava, from September 2010 until September 2013. Patients included in the study were compliant adults patients with 3- and 4-part proximal humerus fractures Neer type IV, V and VI. Twenty patients were treated surgically. The group included 13 women (65%) and 7 men (35%). Mean age was 60.9±7.67 (52-80) years. Angle-stable plates (Philos, Synthes) and intramedullary nails (Multilock, Synthes) were used.The non-surgical group included 19 patients, consisting of 12 (63.2%) women and 7 (36.8%) men. Mean age of both sexes was 66.3±9.5 (5288) years. Gilchrist bandage was applied for the maximum of 3 weeks. All patients were evaluated at 12 months from treatment using the Constant-Murley scoring system and the Oxford Shoulder Score. Treatment complications were evaluated as a secondary step.

RESULTS

The mean individual relative Constant-Murley score was 57.8±23.5% (1188%) in the surgical group. The mean Oxford Shoulder score was 34.8±10.6 (1046) points. Complications were recorded in 12 patients (60%). In the non-surgical group, the mean individual relative Constant-Murley score at 12 months from injury was 60.9±20.9% (1690%). The mean Oxford Shoulder score was 36.1±8.9 (1548) points. Complications were recorded in 4 patients (21.1%).

CONCLUSIONS

In this study, surgical treatment patients with displaced 3- and 4-part proximal humerus fractures, mostly treated by angle-stable plates, showed a number of complications. Poor functional results of the surgical group were comparable to those of the non-surgical group. The indication for surgery, patient selection, type of surgery, surgical experience and subsequent rehabilitation should be carefully assessed for better results.

KEY WORDS

proximal humerus fracture surgical treatment non-surgical treatment 3- and 4-part fractures.

[Economic Analysis of Treatment Courses for Patients Over the Age of 80 Years at a Surgical Maximum Care Centre]

BACKGROUND

The demographic change in Germany with an aging population and the resulting necessity of adequate surgical care for older patients was lately discussed with concern. One major aspect is the estimated higher treatment costs in the care of the elderly.

MATERIALS AND METHODS

InEK data from all cases of patients over the age of 80, who were treated and discharged from 2008 to 2012 as inpatients at the Department of General, Visceral, Vascular and Thoracic Surgery at the Charité - Universitätsmedizin Berlin, Campus Mitte, were analysed. Of a total of 13,612 patients 626 patients were over the age of 80. Their lengths of stay, mode of discharge and discharge management as well as costs and reimbursements according to the relevant diagnosis-related groups were analysed.

RESULTS

Cases of elderly patients amounted to a stable 5 % of all cases from 2008 until 2012. Their mean length of stay was 14 (median, 9), range, 1-129 days. 80 % of patients could be regularly discharged, 9 % died, 8 % were transferred to another hospital, 2 % discharged into a nursing home and 1 % into a rehabilitation centre. The elderly patients had a patient clinical complexity level of mean 2.84. Costs per day amounted to a mean 778 (median: 627) €, range: 306-7740 €, total costs to 10,686 (median: 5140) €, range: 368-186,059 €. The mean deficit was 491 (median: 176) € per patient, range: - 30,470-75,144 €. The discharge management was significantly different in comparison to patients under the age of 80 with respect to avoidance of discharge at the weekend.

CONCLUSION

Patients over the age of 80 are a relevant group in surgery. They have an increased perioperative risk, but patients should not be denied surgery solely because of their age. The perioperative management of the elderly has to be of maximum standardised quality. From an economic perspective it can be stated that elderly patients currently pose no exceptional financial risk to a surgical department, but contribute relevantly to the turnover, whereby special attention has to be paid to an early structured discharge management.

[Hyperthermic intraperitoneal chemotherapy in the German DRG system. Analysis of case cost calculations of a maximum care university]

BACKGROUND

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) offers patients with peritoneal cancer of various origins the chance of a relevant increase in life expectancy. These cases are very complex from a medical viewpoint and very expensive from an economical aspect. An analysis of case cost calculations was performed to find out whether this procedure can on average be carried out cost-effectively by a maximum care university.

MATERIALS AND METHODS

All cases from 2008 in which HIPEC was carried out were analyzed. The types of main diagnosis, secondary diagnoses, procedures, times from incision to suture and hospital stay were analyzed. On the basis of the case costs the proceeds and marginal returns were calculated from the diagnosis-related groups (DRGs) and additional remuneration when applicable. The causes of positive and negative marginal returns were explained using the InEK cost matrix.

RESULTS

In 18 patients there were 9 different main diagnoses and 7 different "main procedures" (from a surgical perspective the most resource intensive procedures) and a total of 10 different DRGs were identified in the grouping algorithm. With an average of 2 operations (range 1-7) per patient the summed incision-to-suture time was 423 min (170-962 min). The patients stayed on average 6.4 days (1.3-17.6 days) in intensive care. The average case cost was 21,072€ (range 8,657-55,904€) and the proceeds 20,474€ (6,333-37,497€). Each case had on average a debit balance of 598€ (range from 11,843€ profit balance to 18,407€ debit balance) with an assumed base rate of 2,786€. The causes for positive or negative marginal profits were mostly operating times, incision-to-suture times and duration of intensive care.

CONCLUSIONS

The proceeds showed on average a deficit of only 3% compared to the costs. The operating times must be decreased by optimization particularly of the preoperative approach. Interventions should be carried out in one stage only and the intraoperative connecting and waiting times should be reduced in order to reduce the incision-to-suture times.

Microbiological and immunological characteristics of young Moroccan patients with aggressive periodontitis with and without detectable Aggregatibacter actinomycetemcomitans JP2 infection

Cross-sectional and longitudinal studies identify the JP2 clone of Aggregatibacter actinomycetemcomitans as an aetiological agent of aggressive periodontitis (AgP) in adolescents of northwest African descent. To gain information on why a significant part of Moroccan adolescents show clinical signs of periodontal disease in the absence of this pathogen we performed comprehensive mapping of the subgingival microbiota of eight young Moroccans, four of whom were diagnosed with clinical signs of AgP. The analysis was carried out by sequencing and phylogenetic analysis of a total of 2717 cloned polymerase chain reaction amplicons of the phylogenetically informative 16S ribosomal RNA gene. The analyses revealed a total of 173 bacterial taxa of which 39% were previously undetected. The JP2 clone constituted a minor proportion of the complex subgingival microbiota in patients with active disease. Rather than identifying alternative aetiologies to AgP, the recorded infection history of the subjects combined with remarkably high concentrations of antibodies against the A. actinomycetemcomitans leukotoxin suggest that disease activity was terminated in some patients with AgP as a result of elimination of the JP2 clone. This study provides information on the microbial context of the JP2 clone activity in a JP2-susceptible population and suggests that such individuals may develop immunity to AgP.

Single-port access in laparoscopic bilateral inguinal hernia repair: first clinical report of a novel technique

PURPOSE

To report the initial clinical case of single-port transabdominal preperitoneal (TAPP) bilateral inguinal hernia repair.

METHODS

One patient with symptomatic bilateral inguinal hernias underwent a single-port TAPP hernia repair using the Triport Single Port System (ASC, TriPort Laparoscopic Access Device, Wicklow, Ireland). The device was placed through a single supraumbilical incision. Hernia repair was performed with a typical TAPP technique with implantation of an Ultrapro Mesh (Ethicon, Norderstedt, Germany).

RESULTS

The procedure was technically successful without placement of additional trocars. Operative time was 120 min. No blood loss and no intraoperative complications were observed. The patient was discharged on the 2nd postoperative day and follow-up at 2 weeks demonstrated the patient to be without complaints with uncomplicated wound healing.

CONCLUSION

Single-port TAPP bilateral inguinal hernia repair is technically feasible and safe.

Actinomyces naeslundii in initial dental biofilm formation

The combined use of confocal laser scanning microscopy (CLSM) and fluorescent in situ hybridization (FISH) offers new opportunities for analysis of the spatial relationships and temporal changes of specific members of the microbiota of intact dental biofilms. The purpose of this study was to analyse the patterns of colonization and population dynamics of Actinomyces naeslundii compared to streptococci and other bacteria during the initial 48 h of biofilm formation in the oral cavity. Biofilms developed on standardized glass slabs mounted in intra-oral appliances worn by ten individuals for 6, 12, 24 and 48 h. The biofilms were subsequently labelled with probes against A. naeslundii (ACT476), streptococci (STR405) or all bacteria (EUB338), and were analysed by CLSM. Labelled bacteria were quantified by stereological tools. The results showed a notable increase in the number of streptococci and A. naeslundii over time, with a tendency towards a slower growth rate for A. naeslundii compared with streptococci. A. naeslundii was located mainly in the inner part of the multilayered biofilm, indicating that it is one of the species that attaches directly to the acquired pellicle. The participation of A. naeslundii in the initial stages of dental biofilm formation may have important ecological consequences.

["Fast-track" rehabilitation in thoracic surgery. First experiences with a multimodal, interdisciplinary, and proven perioperative treatment course]

OBJECTIVES

"Fast-track" rehabilitation is a multimodal perioperative treatment concept for accelerating postoperative recovery which has been already used successfully in visceral surgery. Of its use in thoracic surgery however, almost no data exist and the relevance of this concept for pulmonary operations is unknown.

PATIENTS AND METHODS

In this prospective study we examined a new perioperative fast-track treatment concept for thoracic surgery and evaluated the results. This program employs detailed information of patients, intensive perioperative respiratory therapy, thoracic peridural analgesia, forced mobilization, and an early start of postoperative normal food intake.

RESULTS

Fifty consecutive patients with benign or malignant diseases of the lung aged an average of 64 years (range 22-78) were operated on thoracoscopically (n=15) or with thoracotomy (n=35) and treated perioperatively using the fast-track program. All patients were mobilized beginning 4 h postoperatively and had normal food. The incidence of general postoperative complications was 0% in this study. Postoperative stay lasted 4.5 days (range 1.5-28.5). There was no increase in surgical complications, and 6% of the patients were readmitted. The patients' acceptance of this concept was high.

CONCLUSION

Fast-track rehabilitation resulted in a decreased rate of general complications and accelerated rehabilitation in thoracic surgery.