Annals of translational medicine
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Patients with impaired lung function or chronic obstructive pulmonary disease (COPD) are considered high-risk for intubated general anesthesia, which may preclude them from surgical treatment of their lung cancers. We evaluated the feasibility of non-intubated video-assisted thoracoscopic surgery (VATS) for the surgical management of lung cancer in patients with impaired pulmonary function. ⋯ Non-intubated VATS resection for pulmonary tumors is technically feasible. It may be applied as an alternative to intubated general anesthesia in managing lung cancer in selected patients with impaired pulmonary function.
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Patients receiving a total knee arthroplasty (TKA) who fail to meet inpatient criteria for outpatient physical therapy or an acute rehabilitation facility are increasingly being discharged to skilled nursing facilities (SNFs). However, in some facilities, postoperative care and therapy may be suboptimal. In order to recognize the circumstances predisposing patients to a SNF discharge and quantify perioperative risks, we used a nationwide TKA database to compare those who were and were not discharged to SNFs with respect to: (I) patient and hospital characteristics; (II) comorbidities; (III) lengths of stay (LOS); and (IV) inpatient complications. ⋯ Patients discharged to SNF had specific demographic characteristics and risk factors, increased LOS, more frequent inpatient medical complications, and greater hospital costs. Knowledge of these risk factors may be critical from the perspective of the new value-based reimbursement system for orthopaedic surgeon to intervene early and appropriately select the patients likely and capable of completing the rigorous postoperative TKA rehabilitation.