Video-Assisted Thoracoscopic Day Surgery for Patients with Pulmonary Nodules: A Single-Center Clinical Experience of 200 Cases

Abstract

Background We reviewed our experience with 200 patients who underwent video-assisted thoracoscopic day surgery (VATDS) at the Day Surgery Center at West China Hospital to identify the safety and feasibility of VATDS and assess the value of novel management in patients with pulmonary nodules. Methods Between June 2019 and December 2020, 200 patients with pulmonary nodules underwent VATDS at the Day Surgery Center at West China Hospital. The medical records of these 200 patients were reviewed for age, sex, preoperative history, operative and pathological findings, amount of daily chest tube drainage, procedure method and duration, length of stay (LOS), visual analog scale (VAS), and postoperative pulmonary complications (PPCs). Results There were 45 male and 155 female patients with a median age of 43 years (range 18 to 58 years). A total of 158 (79.00%) patients were diagnosed with lung adenocarcinoma, 35 (17.50%) were diagnosed with chronic inflammation with fibrous hyperplasia, and seven (3.50%) were diagnosed with granulomatous inflammation with necrosis. The mean LOS of the 200 patients was 1.25±0.95 days, and 187 (93.50%) patients were discharged within 24 hours as planned. Thirteen patients were transferred to the thoracic surgery ward for further treatment because of PPCs. The median VAS was 3 points (range 1 to 7 points), and the rate of PPCs was 11.50%. Conclusion Two hundred patients underwent VATDS with an acceptable 24-hour discharge rate. However, selection of patients for VATDS is required, and the implementation of VATDS on a larger scale requires further discussion.

Identification of preoperative risk factors associated with prolonged length of stay after lobectomy

“…Given the limited availability of medical resources and the need to ensure that high-quality medical care is provided as optimally as possible, it is essential to improve the efficiency of hospital bed utilization. In this context, Dong et al [ 6 , 7 ] suggested that only individuals exhibiting abnormal preoperative exam findings should be subsequently admitted to the hospital for appropriate preoperative interventions, as an approach to preoperative patient optimization. This approach can shorten the preparation time for patients prior to hospitalization, but indiscriminately admitting patients to preoperative preparation centers can overlook patients with high risk factors that require lobectomy procedures.…”

Days alive and out of hospital after video-assisted thoracoscopic surgery wedge resection in the era of enhanced recovery

“…The median duration of hospital stay of 1 day is substantially lower than previous findings (3–6 days) across the European Union, the USA, and China 6 , 23 , thereby achieving a median DAOH 90 of 88 days. Although the possibility of day surgery in lung resection for selected patients has been reported 24 , further selection criteria and safety data are needed. The present findings offer a basic rationale for further shortening duration of hospital stay without reducing DAOH with day surgery for a selected group of patients.…”