Preoperative nutrition-enhanced recovery after surgery protocol for thoracic neoplasms.

OBJECTIVES: Because patients' preoperative nutritional status influences the outcomes, we have used a preoperative nutrition program for surgical patients for a 2-year period and compared the results with those from a cohort treated in the previous 2 years. METHODS: We retrospectively reviewed curative thoracic neoplasm resections from July 15, 2016, to July 15, 2018, in patients who had received a preoperative nutritional-enhanced recovery after surgery (N-ERAS) protocol. The protocol consisted of 5 days of an oral immunonutrition drink 3 times daily, daily receipt of probiotics, and a carbohydrate-loading drink the night before surgery. The historical control cohort (standard group) included those patients who had undergone surgery by the same surgeon during the previous 24 months. We excluded patients who had undergone esophageal, diagnostic, benign, emergency, or palliative procedures. Nonparametric and parametric statistical tests were used to analyze the data. RESULTS: The data from 462 patients were analyzed: 229 N-ERAS patients and 233 standard patients. No significant demographic or caseload differences were found between the 2 groups. The major significant outcome differences included fewer postoperative complications (30 [13.1%] in the N-ERAS group vs 60 [25.8%] in the standard group; P < .001) and shorter hospital stays (3.8 ± 1.9 days for the N-ERAS group vs 4.4 ± 2.6 days for the standard group; P = .001). Use of the N-ERAS protocol resulted in a 16% reduction ($2198; P < .001) in the mean direct hospital costs/patient. Consequently, for the N-ERAS cohort, the hospital was likely saved $503,342 during the 2-year period for the 229 patients just by using the N-ERAS protocol. CONCLUSIONS: Thoracic surgeons should consider using the nontoxic, patient-compliant N-ERAS protocol for their patients, with an expectation of improved clinical results at lower hospital costs-an important consideration when exploring methods to decrease costs because hospitals are increasingly being paid by a negotiated prospective bundled payment reimbursement model.

A Primer on Health Economic Evaluations in Thoracic Oncology.

There is growing interest for economic evaluation in oncology to illustrate the value of multiple new diagnostic and therapeutic interventions. As these analyses have started to move from specialist publications into mainstream medical literature, the wider medical audience consuming this information may need additional education to evaluate it appropriately. Here we review standard practices in economic evaluation, illustrating the different methods with thoracic oncology examples where possible. When interpreting and conducting health economic studies, it is important to appraise the method, perspective, time horizon, modeling technique, discount rate, and sensitivity analysis. Guidance on how to do this is provided. To provide a method to evaluate this literature, a literature search was conducted in spring 2015 to identify economic evaluations published in the Journal of Thoracic Oncology. Articles were reviewed for their study design, and areas for improvement were noted. Suggested improvements include using more rigorous sensitivity analyses, adopting a standard approach to reporting results, and conducting complete economic evaluations. Researchers should design high-quality studies to ensure the validity of the results, and consumers of this research should interpret these studies critically on the basis of a full understanding of the methodologies used before considering any of the conclusions. As advancements occur on both the research and consumer sides, this literature can be further developed to promote the best use of resources for this field.

[Visceral and thoracic surgical interventions in patients over 80 years old. Evaluation of cost coverage]. / Viszeral- und thoraxchirurgische Eingriffe bei über 80-Jährigen : Bewertung der Kostendeckung.

Due to the higher incidence of malignant tumours with increasing age, cancer is the second most common cause of death among those aged over 65 years old. Consequently, demographic changes in Germany have resulted in a rising demand for oncological operations in elderly patients which is more cost-intensive. Objective of the present study in the setting of a university surgical department is whether oncological operations on patients over 80 years old is cost-effective in the era of diagnosis-related groups. The revenue and expenditure of 116 cases of patients over 80 years old documented for the years 2005-2007 were collated and evaluated. The calculated average proceeds were compared with cases of patients under 80 years old.The average return was -1493.50 EUR/case for over 80-year olds and was not cost-effective. The presence or absence of complications had a significant impact on proceeds, because the mean return/case without complications was profitable (1297.30 EUR). Medical care of patients over 80 years old was on average cost-effective and generated a profit. Oncological operations in patients under 80 years old were not sufficiently remunerated by the current DRG system. Therefore, there is an economical risk associated with oncological operations in elderly patients.

Thin needle aspiration biopsy of thoracic lesions: impact on hospital charges and patterns of patient care.

All patients who were admitted over a two-year period for evaluation of undiagnosed intrathoracic masses were selected for study. We assessed the impact of thin needle aspiration biopsy (TNAB) of thoracic lesions on actual hospital charges and patterns of patient care. Findings of TNAB reduced the need for diagnostic thoracotomy, shortened the time from admission to diagnosis, reduced the total number of thoracotomies, shortened the length of the hospital stay, and resulted in a significantly reduced average and total hospitalization charge.