Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, Chicago, Illinois; Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Canning Thoracic Institute, Northwestern Medicine, Chicago, Illinois.
Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, Chicago, Illinois; Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Canning Thoracic Institute, Northwestern Medicine, Chicago, Illinois; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
J Surg Res. 2022 Aug;276:242-250. doi: 10.1016/j.jss.2022.02.025. Epub 2022 Apr 5.
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.
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.
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).
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.
电视辅助胸腔镜手术（VATS）技术可缩短术后住院时间（LOS）。然而，术后早期出院是否会增加不良术后事件的风险尚不清楚。我们研究了择期 VATS 肺切除术后较短的 LOS 是否与更高的再入院率或术后并发症发生率相关。
在美国外科医师学院国家外科质量改进计划（ACS NSQIP）数据库中，确定了 2011 年至 2018 年间因肺部肿瘤行电视辅助胸腔镜肺段切除术、肺叶切除术或双肺叶切除术的患者。术后 LOS 被视为有序变量。研究的结果是 30 天再入院和 30 天出院后死亡或严重发病率（DSM）。多变量逻辑回归模型评估了 LOS 与结果的关系。为每种手术确定了最常见的再入院诊断。
在 14418 例患者中，12410 例（86.1%）行肺叶切除术，1764 例（12.2%）行肺段切除术，244 例（1.7%）行双肺叶切除术。肺叶切除术（IQR 2-5）和肺段切除术（IQR 2-4）患者的中位 LOS 为 3 天，双肺叶切除术患者的 LOS 为 4 天（IQR 3-6）。再入院率随入院时间而变化，LOS≤1 天的患者再入院率为 5.0%，LOS≥5 天的患者再入院率为 8.5%。最常见的再入院诊断是气胸（19.0%）和伤口并发症（13.4%）。LOS 每增加一天，再入院的风险就会增加（OR 1.10，95%CI 1.04-1.17，P<0.001）。早期出院与 DSM 之间无关联（OR 1.08，95%CI 0.99-1.18，P=0.070）。
VATS 肺切除术后早期出院与癌症患者手术的再入院率或术后并发症发生率增加无关，对于术后恢复简单的患者，可安全考虑。
