Highlights
- •Earlier discharge following VATS lung resection is not associated with increased rates of readmission or postdischarge complications among patients undergoing surgery for suspected lung cancer.
- •Shorter postoperative length of stay is safe for selected patients whose initial postoperative recovery is uncomplicated.
- •Overall, pneumothorax was the most common reason for readmission following VATS lung resection procedures.
Abstract
Introduction
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.
Methods
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.
Results
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 < 0.001). No association was seen between earlier discharge and DSM (OR 1.08, 95%
CI 0.99-1.18, P = 0.070).
Conclusions
Early discharge following VATS lung resection is not associated with increased rates
of readmission or postoperative complications among patients undergoing surgery for
cancer, and may safely be considered for selected patients with uncomplicated postoperative
recovery.
Keywords
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Article info
Publication history
Published online: April 05, 2022
Accepted:
February 14,
2022
Received in revised form:
January 28,
2022
Received:
October 20,
2021
Identification
Copyright
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