Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
Ann Thorac Surg. 2022 Jul;114(1):234-240. doi: 10.1016/j.athoracsur.2021.06.088. Epub 2021 Aug 10.
Our objective is to assess the feasibility and safety of discharging patients by postoperative day one (POD1) after robotic segmentectomy and lobectomy, and to describe outcomes for patients.
A retrospective analysis was made of a prospectively collected database of a quality improvement initiative by a single surgeon. Factors associated with discharge by POD1 were evaluated using a multivariate logistic regression model.
From January 2018 to July 2020, of 253 patients who underwent robotic anatomic pulmonary resection, 134 (53%) were discharged by POD1, 67% after segmentectomy and 41% after lobectomy. Discharge by POD1 improved with experience and was achieved in 97% of patients after segmentectomy and 68% after lobectomy in the final quartile. Thirty-one patients (12%) were discharged home with a chest tube, including 7 (2.8%) on POD1. On multivariate analysis, never smokers and segmentectomy were associated with discharge by POD1. Conversely, decreased baseline performance status and perioperative complications were associated with discharge after POD1. There were 10 minor morbidities (4%), 6 major morbidities (2.4%), and no 30- or 90-day mortality. There were 4 readmissions (1.6%), of which 1 (0.4%) was after POD1 discharge. Patient satisfaction remained high throughout the study period.
With experience and communication, select patients can be discharged home on POD1 after robotic segmentectomy and lobectomy with excellent outcomes and high satisfaction. Discharge by POD1 was associated with never smokers and segmentectomy, and inversely associated with decreased baseline performance status and perioperative complications.
我们的目的是评估在机器人肺段切除术和肺叶切除术之后，患者在术后第 1 天（POD1）出院的可行性和安全性，并描述患者的结局。
对一名外科医生进行的质量改进计划的前瞻性数据库进行了回顾性分析。使用多变量逻辑回归模型评估与 POD1 出院相关的因素。
从 2018 年 1 月至 2020 年 7 月，在 253 例接受机器人解剖性肺切除术的患者中，有 134 例（53%）在 POD1 出院，其中肺段切除术的出院率为 67%，肺叶切除术的出院率为 41%。随着经验的增加，POD1 出院率得到改善，在肺段切除术的最后一个季度，97%的患者出院，肺叶切除术的 68%的患者出院。31 例（12%）带管出院，其中 7 例（2.8%）在 POD1 出院。多变量分析显示，不吸烟者和肺段切除术与 POD1 出院相关。相反，基线功能状态下降和围手术期并发症与 POD1 后出院相关。有 10 例轻微并发症（4%），6 例严重并发症（2.4%），无 30 天或 90 天死亡率。有 4 例再入院（1.6%），其中 1 例（0.4%）在 POD1 出院后。整个研究期间，患者满意度一直很高。
通过经验和沟通，选择合适的患者在机器人肺段切除术和肺叶切除术后，可以在 POD1 出院，且结局良好，满意度高。POD1 出院与不吸烟者和肺段切除术相关，与基线功能状态下降和围手术期并发症呈负相关。
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