Early discharge after thoracoscopic anatomical pulmonary resection for non-small-cell lung cancer.

Abstract

OBJECTIVES\nAlthough video-assisted thoracic surgery (VATS) has shortened hospitalization duration for non-small-cell lung cancer (NSCLC) patients, the factors associated with early discharge remain unclear. This study aimed to identify patients eligible for a 72-h stay after VATS anatomical resection.\n\n\nMETHODS\nMonocentric retrospective study including all consecutive patients undergoing VATS anatomical resection for NSCLC between February 2010 and December 2019. Two groups were defined according to the discharge: early discharge (within 72 postoperative hours) and routine discharge (at >72 postoperative hours).\n\n\nRESULTS\nA total of 660 patients with a median age of 66.5\u2009years (interquartile range 60-73\u2009years) (female/male: 321/339) underwent VATS anatomical pulmonary resection for NSCLC [segmentectomy in 169 (25.6%), lobectomy in 481 (72.9%), bilobectomy in 8 (1.2%) and pneumonectomy in 2 (0.3%) patients]. The cardiopulmonary and Clavien-Dindo III-IV postoperative complication rates were 32.6% and 7.7%, respectively. The median postoperative length of stay was 6\u2009days (interquartile range 4-10\u2009days). In total, 119 patients (18%) could be discharged within 72\u2009h of surgery. On multivariable analysis, the factors significantly associated with an increased likelihood of early discharge were: body mass index >20\u2009kg/m2 [odds ratio (OR) 2.37], absence of prior cardiopathy (OR 2), diffusing capacity of the lung for carbon monoxide >60% (OR 1.82), inclusion in an enhanced recovery after surgery protocol (OR 2.23), use of a single chest tube (OR 5.73) and postoperative transfer to the ward (OR 4.84). Factors significantly associated with a decreased likelihood of early discharge were: age >60\u2009years (OR 0.53), American Society of Anaesthesiologists score >2 (OR 0.46) and use of an epidural catheter (OR 0.41). Readmission rates were not statistically different between both groups (5.9% vs 3.1%; P\u2009=\u20090.17).\n\n\nCONCLUSIONS\nAge, pulmonary functions and comorbidities may influence discharge after VATS anatomical resection. The early discharge does not increase readmission rates.