Stephen Greer1, Ashley D Miller2, Jeremiah S Smith1, Jenny M Holcombe1, James R Headrick1. 1. Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee. 2. Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee. Electronic address: ashley@drheadrick.net.
Abstract
BACKGROUND: Utilizing our standardized approach to air leak reduction (STAR) protocol has led to a continual decrease in the need for inpatient recovery after lobectomy. Although next-day discharges do occur, the current literature, to our knowledge, has not addressed their safety. We analyzed our STAR data set to study this group and their outcomes. METHODS: A retrospective review of prospectively collected data from the STAR data set was performed. Characteristics were compared between patients discharged on postoperative day (POD) 1 and those with longer admissions. Outcome data was analyzed. RESULTS: From June 2010 through June 2017, 390 patients underwent lobectomy and met study criteria. Of these, 150 (38%) were discharged on POD 1 versus 240 (62%) who were discharged later (mean length of stay, 3.9 days). There was no increase in morbidity, mortality, or 30-day readmission between the 2 groups. Distinguishing characteristics of the POD 1 group included more nonsmokers, use of a minimally invasive technique, and a lower incidence of prolonged air leak. FEV1 (forced expiratory volume in 1 second) and Dlco (diffusing capacity of the lung for carbon monoxide) data were also favorable in the POD 1 group. The percentage of patients sent home POD 1 increased from an average of 23% over the first 3 years of the study to 63% over the last 3 years. CONCLUSIONS: Appropriately identified patients can safely go home on POD 1 after lobectomy without an increase in 30-day readmission, morbidity, or mortality. A continued focus on lobectomy length of stay reduction has the capacity to increase patient satisfaction and lead to reduction in health care costs.
BACKGROUND: Utilizing our standardized approach to air leak reduction (STAR) protocol has led to a continual decrease in the need for inpatient recovery after lobectomy. Although next-day discharges do occur, the current literature, to our knowledge, has not addressed their safety. We analyzed our STAR data set to study this group and their outcomes. METHODS: A retrospective review of prospectively collected data from the STAR data set was performed. Characteristics were compared between patients discharged on postoperative day (POD) 1 and those with longer admissions. Outcome data was analyzed. RESULTS: From June 2010 through June 2017, 390 patients underwent lobectomy and met study criteria. Of these, 150 (38%) were discharged on POD 1 versus 240 (62%) who were discharged later (mean length of stay, 3.9 days). There was no increase in morbidity, mortality, or 30-day readmission between the 2 groups. Distinguishing characteristics of the POD 1 group included more nonsmokers, use of a minimally invasive technique, and a lower incidence of prolonged air leak. FEV1 (forced expiratory volume in 1 second) and Dlco (diffusing capacity of the lung for carbon monoxide) data were also favorable in the POD 1 group. The percentage of patients sent home POD 1 increased from an average of 23% over the first 3 years of the study to 63% over the last 3 years. CONCLUSIONS: Appropriately identified patients can safely go home on POD 1 after lobectomy without an increase in 30-day readmission, morbidity, or mortality. A continued focus on lobectomy length of stay reduction has the capacity to increase patient satisfaction and lead to reduction in health care costs.