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  • SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Robotic lobectomy has been associated with a median length of stay of 4 days. We hypothesized that with a standard Enhanced Recovery After Surgery (ERAS) protocol, robotic lobectomies could be discharged as early as post-operative day 1. METHODS: Between March 2017 and March 2020, a total of 239 robotic-assisted lobectomies were performed by a single surgeon. All operations included additional procedures, such as mediastinal and hilar lymph node dissections, bronchoscopies, en bloc resections, intercostal nerve blocks and lysis of adhesions. RESULTS: 20 patients were discharged home on post-operative day 1. Of these, 13 were female and 7 were male. The average age was 65 years. 8 patients had cardiovascular disease, 2 had chronic kidney disease and 7 had a history of other cancer. The average body mass index was 28.9 kg/m2. The average pack years smoked was 24.3. The average FEV1 was 2.3L which was 87% predicted (median 2.0L, 91% predicted). The average diffusion capacity was 82% predicted (median 79% predicted). 6 patients underwent left lower lobectomy, 5 left upper lobectomy, 4 right upper lobectomy, 3 right middle lobectomy and 2 right lower lobectomy. The most common pathology was adenocarcinoma (7 patients) followed by squamous cell carcinoma (5 patients), and other pathologies in 8 patients. There were 3 post-discharge complications within 30 days requiring intervention; thoracentesis (1 patient), atrial fibrillation with rapid ventricular response (1 patient), and acute kidney injury in a patient with chronic kidney disease (1 patient). There were no readmissions for pleural effusion or pneumothorax. There were no mortalities. CONCLUSIONS: An underemphasized, but very important, additional benefit of robotic lobectomy is shortened length of stay. Our study demonstrates that post-operative day 1 discharge after lobectomy is possible, and is associated with low risk for complication and readmission. Additionally, the application of an ERAS-based care path improves patient outcomes and strengthens team-based collaboration by streamlining post-operative care practices and expectations. This decreased length of hospitalization reduces risks for nosocomial infections (including COVID-19) and improves resource utilization. CLINICAL IMPLICATIONS: Early discharge was the goal of our ERAS protocol applied to all lobectomy patients. Important features include:-Pre-operative education and counseling (including the possibility of day 1 discharge)-Multimodal pain relief regimen-Early out of bed mobilization and ambulation -Atrial fibrillation prophylaxis (usually low dose beta blocker)-Repletion of potassium and magnesium-Water seal of chest tubes post-operative day 1-Early and frequent air leak checks with forced cough and Valsalva maneuver-Chest tube removal when air leak resolved -Discharge same day of tube removal if subsequent chest x-ray without pneumothorax DISCLOSURES: No relevant relationships by Nicole Perez, source=Web Response No relevant relationships by R Thomas Temes, source=Web Response
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