Lung transplant is an effective treatment for end-stage lung disease in selected patients. Management strategies following transplantation remain variable within and between institutions. We have recently applied critical pathways to guide the care of our patients undergoing lung transplantation. Herein, we review the outcomes of patients who underwent isolated lung transplantation following the application of these critical pathways.
We retrospectively reviewed the outcomes of 117 consecutive patients who underwent isolated lung transplantation between January 2000 and December 2003. A single postoperative critical pathway was developed between the specialties of Thoracic Surgery, Pulmonary Medicine, and Critical Care Nursing and employed during the preoperative and postoperative care of patients undergoing lung transplantation. Demographic and outcome data were compiled and analyzed.
During the study period, 62 and 55 patients underwent bilateral and single lung transplantation, respectively. The indication for transplantation was obstructive airway disease (n=43), pulmonary fibrosis (n=30), cystic fibrosis (n=20), sarcoidosis (n=8), pulmonary hypertension (n=5), bronchiolitis obliterans (n=5), lymphangioleimyomatosis (n=3), bronchiectasis (n=2), and scleroderma (n=1). Hospital length of stay was 8.6 days and hospital mortality was 5.98%.
Fast track strategies and the development of institutional, multidisciplinary critical pathways result in lower length of stay, morbidity, and mortality. Our results over the study period compare favorably with both national averages and historical outcomes at our institution.
In the current era of cost containment, shortened hospital length of stay is critically important. ‘Fast tracking’ following lung transplantation is feasible and reduces morbidity and mortality. Implementation of critical pathways requires multidisciplinary input to achieve consensus in patient care.
W.T. Vigneswaran, None.