15 Enhanced recovery after video-assisted thoracoscopy surgery through the physiokinesis program: from pain to power, feeling better, breathing deeper

Background Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that maintains adequate pre- and post-operative well-being following Video-Assisted Thoracoscopy Surgery (VATS).^{1 2} The reasons why VATS patients had a prolonged hospital length of stay (LoS) were found to be inadequate lung expansion, lack of drainage on chest tubes, and unanticipated leaking, which resulted in 10–20% increase in LoS. The project aimed to reduce patient LoS by 30% (from 9 days to 6.3 days) over the end of one year (Dec 2022–Jan 2023).

Methods The Institute for Healthcare Improvement (IHI) Collaborative Model for Improvement was used as a Quality Improvement (QI) approach and different evidence-based practices were tested to come up with the core elements of the Physiokinesis Program.^1–3 These included special arm exercises (usually on the operative side), ^{1 2} proper use of incentive spirometry (IS), deep breathing exercises (DBE), early ambulation, personalized pre-operative teaching,³ and psychological orientation of what to expect post-VATS.³Upon admission, the patient is immediately assessed by physicians and a Physiotherapy (PT) referral is ordered; other components of the Physiokinesis Program are completed by nurses and the physiotherapist. Run and control charts were used to determine if significant shifts occurred in the measures over time.

Results A total of 68 VATS patients were enrolled in the Physiokinesis Program. There was a 56% reduction of LoS (from 9 days to 4 days) for enrolled patients (figure 1), and post-procedure complication rates reduced significantly by 50% (from 2–4 to 0–1 complications per 1,000 patient days) (figure 2).

Conclusion The novel interventions under the Physiokinesis Program were person-centered approaches that effectively reduced patients’ LoS and enhanced their post-surgery recovery. Compliance with Physiokinesis Programs‘ components improved patient outcomes, resulting in 100% of patients responding favourably and ensuring a 100% safe discharge with 0% unplanned readmissions.

References

1. Bertani A, Ferrari P, Terzo D, Russo E, Burgio G, De Monte L, Raffaele F, Droghetti A, Crisci R. A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy. Journal of Thoracic Disease 2018;10(Suppl 4):S499–S511. https://doi.org/10.21037/jtd.2018.02.55

2. Akezaki Y, Nakata E, Tominaga R, Iwata O, Kawakami J, Tsuji T, Ueno T, Yamashita M, Sugihara S. Short-term impact of video-assisted thoracoscopic surgery on lung function, physical function, and quality of life. Healthcare 2021;9(2):136. https://doi.org/10.3390/healthcare9020136

3. Bazezew A, Nuru N, Demssie T. et al. Knowledge, practice, and associated factors of preoperative patient teaching among surgical unit nurses, at Northwest Amhara Comprehensive Specialized Referral Hospitals, Northwest Ethiopia, BMC Nurs 2022;22:20 (2023). https://doi.org/10.1186/s12912-023-01175-2

Ethical Approval/IRB Statement This quality improvement project was granted approval from the Executive Nursing Leadership from the Hamad General Hospital (HGH) in December 2022.

Disclosures and Acknowledgments The authors of the project would like to acknowledge the leaders, supervisors, and patients who were involved in the conceptualization of the project.