Technology to dominate cardio-thoracic conference with lifesaving studies on heart and lung procedures

Toronto 05 May 2000Some 2500 of the world's elite cardio-thoracic surgeons have met at the 80th annual meeting of the American Association for Thoracic Surgery (AATS) to learn and review the latest scientific breakthroughs in heart and lung surgery and disease. Three particular studies at this meeting illustrated how technology improves patient care and the thoracic profession. The first was about early lung cancer detection via CT scan or chest X-ray; the second related to computer enhanced "robotic" cardiac surgery; and the third investigated whether early discharge following coronary artery bypass graft (CABG) surgery leads to cost savings or rather to a shift in costs.


Researchers from New York Hospital, Cornell Medical Center, have shown that screening computed tomography (CT) scans detect lung cancer earlier than traditional chest X-rays. This screening modality may significantly improve survival rates of patients with Stage I lung cancer. Dr. Nasser K. Altorki and his colleagues of Weill Cornell Medical College in New York compared findings in 103 patients referred to them when their tumour was detected on routine chest X-ray with findings from 20 patients who had been referred with a tumour detected on screening CT scan.

The researchers found a "significantly greater" number of cases of stage 1A disease in the CT group than in the X-ray group. Specifically, 75% of the CT scan group had stage IA tumours compared with 40% of those in the X-ray group. Of the 15 patients with stage I disease in the CT group, 7 had tumours 1 cm or less versus 8 of 74 stage I patients detected by chest X-ray, according to the researchers in an abstract of their presentation. The findings suggest that the opportunity exists to pick up lung cancer early with CT scan, in order to provide patients with treatment at a moment when this is more meaningful, as Dr. Altorki stated.

In the second study, German surgeons performed tests with a computer-enhanced instrumentation system for heart bypass and endoscopic mitral valve repair. The first results are based on interventions involving a number of 100 patients. The authors found the robotic system allows more precise tissue handling for surgical tasks which require a high degree of dexterity. The authors believe that this experimental study can possibly pave the way for enhanced endoscopic computer-guided surgery.

The CABG surgery study showed that the length of hospital stays for heart bypass patients has shortened, and examined whether this practice results in cost savings or merely cost shifting. The report found that the anticipated savings from early patient discharge might be offset due to an increased use of outpatient nursing services, discharges to rehabilitation facilities as well as hospital re-admissions. Dr. Harold L. Lazar and his colleagues from the Boston Medical Center and the Boston University School of Medicine, in Massachusetts, analysed patterns of discharge for 330 patients, submitted to CABG in 1990 according to the protocols of the day, which did not include early extubation, fast track protocols or targeted length of stay. The patterns were compared with 334 patients who underwent CABG in 1998, when such protocols were in place.

The researchers reported that the average length of stay following CABG in the 1998 group was 5.4 days compared with 9.2 days for the 1990 group. This means an average difference of 3.8 days in length of stay between the two groups. But after hospital discharge, only 56% of patients undergoing CABG in 1998 actually went home, compared with 97% of patients in the 1990 group. According to the study, only 15% of patients were sent home with outpatient nursing services in 1990. In comparison, almost 47% of 1998 patients required home nursing services following hospital discharge. Forty-three percent of the 1998 cohort were discharged to an extended care facility, where the average length of stay was 10.6 days. This compared with only 3% of 1990 CABG patients, who also required extended care services.

The researchers pointed out that 1998 patients were older and sicker than the 1990 group. The 1998 CABG patients had more class IV angina, more urgent or emergent surgery, and lower ejection fractions. This group also had more vessels bypassed than their earlier counterparts and longer cross-clamp times. Despite these differences, 1998 patients were able to come off ventilators earlier than the 1990 group, as Dr. Lazar indicated. There was no increase in mortality in the 1998 group, and the results were not different between the two groups. While the approach of an early discharge may be suitable for low-risk patients who are capable of going home, it may be better to keep sicker patients in the hospital for up to seven days following CABG, as Dr. Lazar suggested, after which point it is more likely that they can be discharged home.

Leslie Versweyveld

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