Reply to Fibla et al.

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Abstract
We thank Fibla et al. [1] for their letter. Answering their questions, first, we did not have oxygen-dependent patients nor acute cases in our randomized study [2]. It would not have been proper to enroll critically ill patients in a new technology project. The mean hospital stay calculated from the incriminated (‘excessively long’) 7 days is partly due to an usually 2-day (1–5 days) long preoperative investigative period in our tertiary referral center with a waiting list less than 2 weeks. Our postoperative period ranging from 2 to 16 days with an average of 4.6 days, still can be regarded as unnecessarily long by those who focus exclusively on hospital stay. However, we consider other aspects equally important. Reducing operative time, improving specimen quality, avoiding metal clips, and patient's safety were also among our aims. The particular circumstances of a certain procedure include not only medical aspects but also socio-legal aspects. If the existing legal/judicial system is a strongly patient friendly one – like ours – an even minor out-of hospital postoperative complication can lead to the verdict of professional negligence. The hospital manager's new mantra: 1 day surgery for reducing costs while increasing patient satisfaction. The result is an early discharge race. Nevertheless, sending home a patient is a double-edged sword. Should anything happen afterwards related (or supposedly related) to the previous procedure, the surgeon is at the mercy of the judge. Did anybody ever hear a hospital manager accused of pressing too hard his doctor? Ought we make our managers satisfied or should we make our patients and their lawyers happy? Are we still responsible professionals rather than health-care employees [3]? Are we still bound to the Hyppocrates’ Oath—to protect our patients and defend ourselves? Obviously the answer is a very complex one. What we deny is a race in hours/days of tubing. Safety and patient appeasement are not exactly the same. How long should we keep the average patient in hospital to avoid that particular one, who will develop complication and will sue us? A fair number of chest patients could be operated on even without leaving tubes behind at all. The problem is that no one of us is able to predict convincingly those patients who would really need the tube. We are afraid that with the present force of push of the law the hopes for an ideal solution are fading away.

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