There is something special going on inside NYU Langone’s thoracic surgery service line.
Not only does the thoracic surgery team perform more surgeries than the national average, it reports no 30- and 90-day mortalities. The team also sends patients home much sooner than the national average, with 90% of lobectomy patients and 95% of segmentectomy patients being discharged within 24 hours, according to a Dec. 18 news release from the health system.
One reason for these statistics is the team’s embrace of minimally invasive robotic surgeries, with more than 98% of their operations being performed robotically.
Another reason is the team’s leader, Robert Cerfolio, MD — although he may disagree. He serves as chief of the division of thoracic surgery at NYU Grossman School of Medicine and director of thoracic surgery NYU Langone Health, both based in New York City.
“The story should be about NYU Langone, not about me,” he said when sharing more about his team’s achievements with Becker’s.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is the driving strategy behind your team’s ability to shorten length of stay while sustaining both high volume and exceptional outcomes?
Dr. Robert Cerfolio: I’ve been interested in the fact that doctors keep people in the hospitals way too long for 20 years. They do it because they think it makes them nice, but it drives me crazy.
First of all, it triples our cost. Second of all, it keeps people in the recovery rooms and the operating rooms. Third of all, there are people with cancer who can’t get in the hospital because there are people in beds who shouldn’t be here.
Really, shortening stays is a multifactorial conversation and it takes commitment, but it’s about what’s doing what’s best for the patient. Patients do dramatically better out of the hospital.
Q: What are the key components of your care coordination model that make 24-hour discharge timelines possible?
RC: We do this by first establishing with the patient that we love them and that we’re not kicking them out. We explain to the patients that going home sooner is better for them.
Second, you have to get tubes out quickly. I’m taking chest tubes out in the operating room. Chest tubes add pain, they add to length of stay, complications and infections. If surgeons can get over the dogma and the mindsets around chest tubes, they can take them out within two hours and send people home in a day. I do give people my cell phone and ask them to keep me updated on how they are doing. And we also shift a little of the work to outpatient, because you still have to take care of them.
Q: What are the most critical factors for hospital and health system leaders to consider when looking to expand their robotic surgery programs?
RC: It’s not about expanding robotics, it’s about expanding better care for our patients. If you’re going to expand a robotic program, you need to really expand your team’s expertise.
I’ve had 3,200 surgeons come visit me, proud of that. And I coach more than 10 surgeons personally. I’ve operated in 21 countries. I love when I go there to teach, but every place I go, there’s something they’re doing better than us that we take back. We can also all learn from one another remotely with video.
Q: What do you see on the horizon for robotic surgery?
RC: Right now the Da Vinci 5 has a feature that allows you to remotely call into other people’s operating rooms and use arrows to assist with a procedure. In an ideal world, I could sit at a robotic console in my office, take the controls and do an operation. That’s not here yet, but it’s coming.
In fact, I built an extension onto my summer home with all this computer stuff because I know it’s coming. Maybe when I finally want to retire in 20 years, I can remotely help people operate — what an amazing impact that would be.
The problem is our laws. I can’t even see a patient in Connecticut because I’m in New York. My driver’s license works in Connecticut, why would a medical license be any different? It’s kind of silly.
The second thing would be AI, but patients are not ready for that. Patients don’t want a robot to do their operation. I have surgeons who get mad at me when I say the robots will be 10,000 times better than us. But why do we think we’re ever going to be better than a robot that never gets tired, never is in a bad mood, never has a fight with their wife or the dog on the way to work? We’re not there yet either, but that’s coming.
