Length of Postoperative Hospital Stay and Related Factors After Lobectomy for Lung Cancer: A Pre-enhanced Recovery After Surgery (ERAS) Single Center Assessment

Abstract

Background: Lobectomy for lung cancer often presents a lot of potentially severe complications after surgery for patients. Enhanced Recovery After Surgery (ERAS) is a program to improve unexpected events. When implementing ERAS, there needs to be evidence of relevant factors that prolong hospital stays to encourage the participation of medical staff and leaders. This study is to determine the length of hospital stay (LOS) and its related factors after surgery in patients undergoing lobectomy for non-small cell lung cancer.Methods: A descriptive retrospective study was conducted on 99 patients undergoing lobectomy for nonsmall cell lung cancer at University Medical Center Ho Chi Minh City. Data were extracted from a computerized database of patients who were hospitalized for lobectomy in the treatment of non-small cell lung cancer from January 2018 to December 2021. The primary outcome was the postoperative LOS.Results: Median postoperative LOS was 5.2 days (interquartile range 4.8 to 6.8 days). The complication rate was 19.2%, of which Clavien-Dindo II accounted for the highest at 9.1%. The 30-day readmission rate was 13.1%. The median of LOS in the current cigarette smoker's group was 1.9 days higher than the nevercigarette smoker's group and 1.5 days higher than the former cigarette smokers (p<0.001). Tumor-nodesmetastasis (TNM) stage III showed the highest LOS compared to other stages (p=0.029). Open surgery and thoracoscopic conversion to open showed postoperative LOS about two days longer than thoracoscopic surgery (p<0.001). Performing muscle relaxation and early extubation, multimodal analgesia reduced postoperative LOS by 1.6 days (p<0.001), and preoperative physical therapy and early physical therapy at recovery reduced postoperative LOS by 1.3 days (p<0.001). There was a strong positive correlation between the duration of endotracheal retention, duration of thoracic drainage, amount of blood loss, and postoperative LOS (R>0.5, p<0.001). The duration of the Post-Anesthesia Care Unit and fasting time after surgery showed an average positive correlation with postoperative LOS (0.3<R<0.5, p<0.001). Preoperative fasting time had a weak positive correlation with postoperative LOS (R=0.265, p=0.008).Conclusions: The median postoperative LOS was 5.2 days, and more than half of patients stayed in the hospital for over five days. Some factors affect the LOS, including current cigarette smokers, TNM stage, surgical approaches, some care processes such as early extubation, multimodal pain relief, physical therapy, vomiting, duration of thoracic drainage, amount of blood loss, duration of Post-Anesthesia Care Unit (hours), duration of thoracic drainage (days), preoperative and postoperative fasting time (hours). The study results help propose many changes in perioperative care for patients undergoing lung cancer surgery.