RESUMO
BACKGROUND: A horizontally integrated multidisciplinary clinical guideline was created and implemented in 1999-2000 for minimally invasive thoracic surgery (MIS). Guideline elements included complete appropriate preoperative evaluation, minimally invasive surgery techniques, aggressive anesthetic management and absolute pain control, immediate extubation, abolition of "routine" laboratory and imaging investigations, and early and aggressive postoperative patient mobilization in an integrated, multidisciplinary postthoracotomy rehabilitation program. METHODS: In a retrospective controlled cohort study, data were collected for the 501 procedures performed on 311 patients (MIS group) from July 1, 2000, to June 30, 2001, and for 130 similar procedures performed on 90 similar patients under a standard general thoracic surgery ad hoc clinical program from July 1, 1998, to June 30, 1999. RESULTS: After implementation of the clinical guideline, services expanded with a 345% increase in case volume, a 40% reduction in cost, no adverse effects, and increased referring-physician and patient satisfaction. DISCUSSION: Significant performance improvement was realized by implementing a multidisciplinary clinical guideline for thoracic surgery that seamlessly integrated all facets of diagnosis, therapy, and rehabilitation.
