Early Discharge After Lobectomy for Lung Cancer Does Not Equate to Early Readmission

Patel, Deven C.; Leipzig, Matthew; Yang, Chi‐Fu Jeffrey; Wang, Yoyo; Shrager, Joseph B.; Backhus, Leah M.; Lui, Natalie S.; Liou, Douglas Z.; Berry, Mark F.

doi:10.1016/j.athoracsur.2021.05.053

Cited by 14 publications

(17 citation statements)

References 30 publications

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“…Many attempts have been made to identify underlying risk factors for early discharge. And these studies have demonstrated that increasing age, male sex, higher BMI, and ASA grade, smokers, history of dyspnea, lower FEV 1 % predicted, DLCO < 60%, thoracotomy, prolonged operative time and use of multiple chest tube or epidural catheter all decreased the likelihood of early discharge 11,15–19 . By comparison, our study also verified that older age, male sex, type of resection, and prolonged operative time were independent risk factors for discharge after postoperative Day 2.…”

Section: Resultssupporting

confidence: 80%

Analysis for discharge within 2 days after thoracoscopic anatomic lung cancer surgery

Chen

Ren

et al. 2023

Cancer Medicine

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Objectives:The risk and beneficial factors of early discharge after thoracoscopic anatomic lung cancer surgery are unknown, and this study aims to investigate predictors and associated 30-day readmission for early discharge. Methods:We performed a single-center retrospective analysis of 10,834 consecutive patients who underwent thoracoscopic anatomic lung cancer surgery. Two groups were determined based on discharge date: "discharged by postoperative Day 2" and "discharged after postoperative Day 2." Univariable and multivariable analysis were conducted to identify predictors for discharge. Using propensity score matching (PSM) to compare 30-day readmission rate between two cohorts.Results: A total of 1911 patients were discharged by postoperative Day 2.Multivariable analysis identified older age (odds ratio (OR) = 1.014, p < 0.001), male sex (OR = 1.183, p = 0.003), larger tumor size (OR = 1.248, p < 0.001), pleural adhesions (OR = 1.638, p = 0.043), lymph nodes calcification (OR = 1.443, p = 0.009), advanced clinical T stage (vs. T < 2, OR = 1.470, p = 0.010), lobectomy resection (vs. segmentectomy resection, OR = 2.145, p < 0.001) and prolonged operative time (OR = 1.011, p < 0.001) as independent risk factors for discharge after postoperative Day 2. Three adjustable variables including higher FEV 1 / FVC (OR = 0.989, p = 0.001), general anesthesia (GA) plus thoracic paravertebral blockade (vs. GA alone, OR = 0.823, p = 0.006) and uni-portal thoracoscopic surgery (vs. multi-portal, OR = 0.349, p < 0.001) were associated with a decreased likelihood of discharge after postoperative Day 2. Before and after a 1:1 PSM, discharged by postoperative Day 2 did not increase the risk of 30-day readmission compared to counterparts. Conclusions:Carefully selected patients can be safely discharged within 2 days after thoracoscopic anatomic lung cancer surgery. Three modifiable variables may be favorable for promoting discharge by postoperative Day 2.

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Section: Resultssupporting

confidence: 80%

Analysis for discharge within 2 days after thoracoscopic anatomic lung cancer surgery

Chen

Ren

et al. 2023

Cancer Medicine

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“…Several publications demonstrated that early discharge after thoracic surgery was safe and did not result in significantly higher readmission rates [71][72][73][74]. Therefore, to minimise the impact of postoperative atrial fibrillation on hospital resources, it might be argued that rhythm control is not mandatory before discharge in asymptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Predictors and impact of postoperative atrial fibrillation following thoracic surgery: a state‐of‐the‐art review

Diallo

Brouillard

Raymond³

et al. 2023

Anaesthesia

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Summary This review of 19 studies (39,783 patients) of atrial fibrillation after thoracic surgery addresses the pathophysiology, incidence, and consequences of atrial fibrillation in this population, as well as its prevention and management. Interestingly, atrial fibrillation was most often identified in patients not previously known to have the disease. Rhythm control with amiodarone was the most commonly used treatment and nearly all patients were discharged in sinus rhythm. Major predictors were age; male sex; history of atrial fibrillation; congestive heart failure; left atrial enlargement; elevated brain natriuretic peptide level; and the invasiveness of procedures. Overall, patients with atrial fibrillation stayed 3 days longer in hospital. We also discuss the importance of standardising research on this subject and provide recommendations that might mitigate the impact postoperative atrial fibrillation on hospital resources.

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“…Secondly, patients undergoing thoracic day surgery need strict inclusion indications, excluding high-risk factors such as myocardial infarction, cerebral infarction, and pulmonary embolism. Surgeons can use these ndings to develop patient-speci c treatment plans and select patients that are most likely to succeed with an accelerated discharge [4].…”

Section: Discussionmentioning

confidence: 99%

“…A total number of 48 patients in a single medical group were included in study from June 2019 to November 2019, the results were primarily analyzed for LOS, hospitalization costs and complications. Patel et al [4] enrolled patients from American College of Surgeons National Surgical Quality Improvement Program database and analyzed the outcomes of patients who were discharged on postoperative day 1 (POD1) with normal approach group. Drawbert et al [2] summarized patients with stage I non-small cell lung cancer (NSCLC) from 2010 to 2015 and research objects including two groups: POD 1 discharge group and standard inpatient discharge group.…”

Section: The Characteristics Of Included Studiesmentioning

confidence: 99%

Safety and effectiveness of thoracic day surgery in patient with lung cancer

Shen

Che

2023

Preprint

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Background The successful implementation of the Enhanced recovery after surgery (ERAS) concept in thoracic surgery has made it possible to complete the surgery in the day surgery unit. However, it is still unclear whether day surgery for lung cancer patients can achieve the same results. Methods A systematic literature search was completed in PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), and Web of Science for studies published from 1995 to May 2022. The quality of the articles was evaluated using the Newcastle-Ottawa Scale (NOS) and the data analyzed using the Review Manager 5.3 software. Results We ultimately included 7 retrospective articles that met our criteria for the study. Age, smoking status of patient, comorbidity before the day surgery and pulmonary function tests were better than in inpatient surgery group. Minimally invasive surgical method with segmentectomy was more used in day surgery group than in normal surgery group. The 30-day mortality was also lower in day surgery group and it displayed that early discharged patients had fewer overall complications than the inpatient surgery group. Conclusions Thoracic day surgery has more advantages over inpatient surgery for patient with lung cancer and safe POD1 discharge.

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Early Discharge After Lobectomy for Lung Cancer Does Not Equate to Early Readmission

Cited by 14 publications

References 30 publications

Analysis for discharge within 2 days after thoracoscopic anatomic lung cancer surgery

Analysis for discharge within 2 days after thoracoscopic anatomic lung cancer surgery

Predictors and impact of postoperative atrial fibrillation following thoracic surgery: a state‐of‐the‐art review

Safety and effectiveness of thoracic day surgery in patient with lung cancer

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