Discharging Patients by Postoperative Day One after Robotic Anatomic Pulmonary Resection.

Abstract

BACKGROUND\nOur objective is to assess feasibility, safety, and to describe outcomes for patients discharged by postoperative day one (POD1) after robotic segmentectomy and lobectomy.\n\n\nMETHODS\nA retrospective analysis 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.\n\n\nRESULTS\nFrom January 2018 to July 2020, 253 patients underwent robotic anatomic pulmonary resection of which 134 (53%) discharged by POD1, 67% post segmentectomy and 41% post lobectomy. Discharge by POD1 improved with experience and was achieved in 97% of patients post segmentectomy and 68% post lobectomy in the final quartile. Thirty-one (12%) patients 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 (4.0%) minor morbidities, 6 (2.4%) major morbidities, and no 30 or 90-day mortalities. There were 4 readmissions (1.6%), of which one (0.4%) was after POD1 discharge. Patient satisfaction remained high throughout the study period.\n\n\nCONCLUSIONS\nWith 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.