Exploring hospital and physiotherapy length of stay following thoracic surgery

Purpose

The number of thoracic surgical procedures performed in the United Kingdom continues to increase annually putting pressure on thoracic surgical bed capacity. Reducing hospital length of stay (LOS) following thoracic surgery can help to reduce pressure on hospital beds. The purpose of this service evaluation is to explore hospital and physiotherapy LOS for individuals following thoracic surgery at our hospital and identify whether any factors influence hospital and Physiotherapy LOS. The findings could potentially allow the identification of individuals at risk of longer LOS and help direct physiotherapy rehabilitation provision to these individuals.

Approach

Data was collected over a 12 month period from 1st July 2015 - 30th June 2016 for all patients seen by the cardiothoracic physiotherapy team following thoracic surgery. Data was collected retrospectively using information from patients' physiotherapy ward sheets, chest radiograph and Nexus interconnect clinical hub. Data collected included: - number of days postoperatively discharged from in-patient physiotherapy services, number of days postoperatively discharged from the hospital, day first mobilised postoperatively, gender, age, month surgery performed, type of surgery incision and surgery performed. Data was reviewed, analysed and presented as descriptive statistics.

Outcomes

367 patients underwent thoracic surgery and were seen by the cardiothoracic physiotherapy between 1st of July 2015 and 30th June 2016. Median hospital LOS and median physiotherapy LOS was 5 days. Factors found to influence hospital and physiotherapy LOS were gender, age, type of surgical incision and day first mobilised postoperatively. Median hospital and physiotherapy LOS was longer for female individuals than male individuals. Median hospital and physiotherapy LOS was longer for individuals who underwent a thoracotomy incision than individuals who underwent a Video-assisted thoracoscopic surgery (VATS) incision. Individuals over 45 years old had a longer median hospital and physiotherapy LOS than those under 45 years old. Median hospital and physiotherapy LOS was also longer for those who first mobilised from day 3 onwards postoperatively than those who first mobilised day 1 and 2 postoperatively.

Cost and savings

There were nil costs and nil savings.

Implications

Median hospital LOS and physiotherapy LOS for patients following thoracic surgery was 5 days. Hospitals and physiotherapy LOS were longer for individuals who were female, aged over 45 years old, underwent a thoracotomy and first mobilised from day 3 onwards postoperatively. Directing more intensive physiotherapy rehabilitation to these individuals postoperatively is worth exploration to ascertain whether this could reduce hospital and physiotherapy LOS.

Limitations included the retrospective collection of data from physiotherapy ward sheets rather than medical notes and the possibility that not all individuals who underwent thoracic surgery were referred to physiotherapy. There was also incomplete data for a small number of individuals repatriated to other hospitals.

Median Hospital LOS and physiotherapy LOS following thoracic surgery was 5 days Factors found to influence hospital and physiotherapy LOS were gender, age, type of surgical incision and day first mobilised postoperatively.

Hospital LOS and physiotherapy LOS were longer for individuals who were female, aged over 45 years old, underwent a thoracotomy and first mobilised day 3 and onwards postoperatively.

Top three learning points

  1. Median hospital and physiotherapy LOS was 5 days
  2. Hospital and physiotherapy LOS tended to be longer for patients who underwent a thoracotomy and took longer to mobilise following surgery
  3. Hospital and physiotherapy LOS tended to be longer for female patients and patients over 45 years old

Fund acknowledgements

This work is unfunded.

Thanks go to the cardiothoracic physiotherapy team at Blackpool Teaching Hospitals NHS Foundation Trust

Additional notes

This work was presented at Physiotherapy UK 2018