TY - JOUR

T1 - Days alive and out of hospital after enhanced recovery video-assisted thoracoscopic surgery lobectomy

AU - Huang, Lin

AU - Frandsen, Mikkel Nicklas

AU - Kehlet, Henrik

AU - Petersen, René Horsleben

N1 - Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

PY - 2022

Y1 - 2022

N2 - OBJECTIVES: Days alive and out of hospital (DAOH) integrates overall information of hospitalization, readmissions, and mortality that have been applied as a new outcome measure. However, DAOH after video-assisted thoracoscopic surgery (VATS) in an established enhanced recovery after surgery (ERAS) programme has not been reported. METHODS: Patients aged ≥18 years with non-small-cell lung cancer undergoing VATS lobectomy in an established ERAS programme were eligible. The primary and secondary outcomes were DAOH during the first postoperative 365 days and reasons for reduced DAOH. RESULTS: A total of 316 consecutive patients with well-defined inclusion criteria and complete follow-up were assessed retrospectively. The median length of stay was 3 days (IQR 2-6). The medians (IQR) of postoperative 30, 60, 90, 180 and 365 DAOH were 27 (22-28), 57 (51-58), 86 (80-88), 176 (169-178) and 359 (349-363) days, respectively. Air leak was the dominant factor for reduced DAOH from postoperative day (POD) 0-30 (47.2%) and 0-365 (38.3%). Side effects of adjuvant chemotherapy were dominant from POD 31-60 and 61-90 (23.5% and 47.1%) and recurrence/metastases from POD 91-180 and 181-365 (25.6% and 50.0%). A low diffusing capacity for carbon monoxide (odds ratios 1.28, 95% confidence interval 1.07-1.53; P=0.007) and prior surgical history (odds ratios 1.80, 95% confidence interval 1.08-2.99; P=0.023) were predictors for low DAOH. CONCLUSIONS: DAOH after 1 year with an established VATS lobectomy ERAS programme was only reduced with a median of 6 days. The main factors reducing DAOH were air leak, adjuvant chemotherapy and recurrence. DAOH may be an important patient-centred outcome to define future improvement strategies.

AB - OBJECTIVES: Days alive and out of hospital (DAOH) integrates overall information of hospitalization, readmissions, and mortality that have been applied as a new outcome measure. However, DAOH after video-assisted thoracoscopic surgery (VATS) in an established enhanced recovery after surgery (ERAS) programme has not been reported. METHODS: Patients aged ≥18 years with non-small-cell lung cancer undergoing VATS lobectomy in an established ERAS programme were eligible. The primary and secondary outcomes were DAOH during the first postoperative 365 days and reasons for reduced DAOH. RESULTS: A total of 316 consecutive patients with well-defined inclusion criteria and complete follow-up were assessed retrospectively. The median length of stay was 3 days (IQR 2-6). The medians (IQR) of postoperative 30, 60, 90, 180 and 365 DAOH were 27 (22-28), 57 (51-58), 86 (80-88), 176 (169-178) and 359 (349-363) days, respectively. Air leak was the dominant factor for reduced DAOH from postoperative day (POD) 0-30 (47.2%) and 0-365 (38.3%). Side effects of adjuvant chemotherapy were dominant from POD 31-60 and 61-90 (23.5% and 47.1%) and recurrence/metastases from POD 91-180 and 181-365 (25.6% and 50.0%). A low diffusing capacity for carbon monoxide (odds ratios 1.28, 95% confidence interval 1.07-1.53; P=0.007) and prior surgical history (odds ratios 1.80, 95% confidence interval 1.08-2.99; P=0.023) were predictors for low DAOH. CONCLUSIONS: DAOH after 1 year with an established VATS lobectomy ERAS programme was only reduced with a median of 6 days. The main factors reducing DAOH were air leak, adjuvant chemotherapy and recurrence. DAOH may be an important patient-centred outcome to define future improvement strategies.

KW - Days alive and out of hospital

KW - Enhanced recovery

KW - Outcome

KW - Perioperative medicine

KW - Pulmonary surgery

U2 - 10.1093/ejcts/ezac148

DO - 10.1093/ejcts/ezac148

M3 - Journal article

C2 - 35234866

AN - SCOPUS:85138457793

VL - 62

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 3

M1 - ezac148

ER -