Wu Shilong, Liu Jun, Liang Hengrui, Ma Yanzhi, Zhang Yaoliang, Liu Hui, Yang Hanyu, Xin Tuo, Liang Wenhua, He Jianxing
Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Ann Transl Med. 2020 Jun;8(12):740. doi: 10.21037/atm-20-287.
Prolonged length of stay after surgery is considered to increase cost and hospital-acquired complications. Therefore, we aimed to identify the risk factors that were associated with an increased length of stay after mediastinal tumor resection in the setting of an enhanced recovery after surgery (ERAS)-TUBELESS protocol.
This prospective cohort study collected data on consecutive patients undergoing video-assisted thoracoscopic surgery (VATS) resection for mediastinal tumor between December 2015 and November 2018 at a single center in China. All patients followed the ERAS-TUBELESS protocol. A length of stay after VATS tumor resection (LOS) greater than 3 days was considered an increased LOS. Univariable and multivariable logistic regression models were used to identify potential factors associated with increased LOS. Factors were divided into patient-related risk factors and procedure-related risk factors.
A total of 204 patients were included, of which 85 (41.67%) patients had a LOS of more than 3 days. The median LOS for the entire cohort was 3 days. All the patient-related risk factors had no significantly associated with a prolonged LOS. Procedure-related risk factors that were significantly associated with a prolonged LOS were surgeon, operation time, intraoperative blood loss, drainage tube, analgesic drugs, and complications. Anesthesia with spontaneous ventilation was correlated with early discharge (LOS ≤1 day).
In the setting of an ERAS-TUBELESS protocol, the main drivers of LOS were procedure-related factors. Anesthesia with spontaneous ventilation was associated with early discharge (LOS ≤1 day) and thus promoted thoracic day surgery.
手术后住院时间延长被认为会增加成本和医院获得性并发症。因此，我们旨在确定在手术后加速康复（ERAS）-无管方案背景下，与纵隔肿瘤切除术后住院时间延长相关的危险因素。
这项前瞻性队列研究收集了2015年12月至2018年11月在中国某单一中心连续接受电视辅助胸腔镜手术（VATS）切除纵隔肿瘤患者的数据。所有患者均遵循ERAS-无管方案。VATS肿瘤切除术后住院时间（LOS）大于3天被视为住院时间延长。采用单变量和多变量逻辑回归模型来确定与住院时间延长相关的潜在因素。因素分为患者相关危险因素和手术相关危险因素。
共纳入204例患者，其中85例（41.67%）患者住院时间超过3天。整个队列的中位住院时间为3天。所有患者相关危险因素与住院时间延长均无显著相关性。与住院时间延长显著相关的手术相关危险因素包括外科医生、手术时间、术中失血、引流管、镇痛药和并发症。自主通气麻醉与早期出院（LOS≤1天）相关。
在ERAS-无管方案背景下，住院时间延长的主要驱动因素是手术相关因素。自主通气麻醉与早期出院（LOS≤1天）相关，从而促进了胸科日间手术。
