National Assessment of Early Discharge After Video-Assisted Thoracoscopic Surgery for Lung Resection

Video-assisted thoracoscopic surgery (VATS) techniques permit shorter postoperative length of stay (LOS). However, it remains unknown whether earlier discharge increases the risk of adverse postoperative events. We examined whether shorter LOS following elective VATS lung resection was associated wi...

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Bibliographic Details
Published in:The Journal of surgical research 2022-08, Vol.276, p.242-250
Main Authors: Mahenthiran, Ashorne K., Brajcich, Brian C., Kim, Samuel, Bharat, Ankit, Odell, David D.
Format: Article
Language:English
Subjects:
Aftercare
Humans
Length of Stay
Lobectomy
Lung
Lung cancer surgery
Lung Neoplasms - complications
Lung Neoplasms - surgery
Patient Discharge
Pneumonectomy - adverse effects
Pneumonectomy - methods
Postoperative care
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Postoperative Complications - surgery
Retrospective Studies
Segmentectomy
Thoracic Surgery, Video-Assisted - adverse effects
Thoracic Surgery, Video-Assisted - methods
Video-assisted thoracoscopic surgery
Wedge resection
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Summary:Video-assisted thoracoscopic surgery (VATS) techniques permit shorter postoperative length of stay (LOS). However, it remains unknown whether earlier discharge increases the risk of adverse postoperative events. We examined whether shorter LOS following elective VATS lung resection was associated with increased rates of readmission or postoperative complications. Patients who underwent elective thoracoscopic segmentectomy, lobectomy, or bilobectomy for lung neoplasms from 2011 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) dataset. Postoperative LOS was treated as an ordinal variable. The examined outcomes were 30-d readmission and 30-d postdischarge death or serious morbidity (DSM). Multivariable logistic regression models evaluated the association of LOS with outcomes. The most common readmission diagnoses were identified for each operation. Among 14,418 patients, 12,410 (86.1%) underwent lobectomy, 1764 (12.2%) underwent segmentectomy, and 244 (1.7%) underwent bilobectomy. The median LOS was 3 d for patients undergoing lobectomy (IQR 2-5) and segmentectomy (IQR 2-4), and 4 d for bilobectomy (IQR 3-6). Readmission rates varied with admission time and ranged from 5.0% for patients with LOS ≤1 d to 8.5% for LOS ≥5 d. The most common readmission diagnoses were pneumothorax (19.0%) and wound complications (13.4%). Each one-day increase in LOS was associated with an increased risk of readmission (OR 1.10, 95% CI 1.04-1.17, P 
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2022.02.025