Christopher W Towe1, Alina Khil1, Vanessa P Ho2, Yaron Perry1, Luis Argote-Greene1, Katherine M Wu1, Philip A Linden1. 1. Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA. 2. Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery. MetroHealth Medical Center and Case Western Reserve School of Medicine, Cleveland, OH, USA.
Abstract
BACKGROUND: The average hospitalization after lung resection is 6 days, but some patients are discharged early in the post-operative period. The patient factors associated with early discharge (ED) and the safety of this approach are unknown. We hypothesized that specific patient populations are associated with ED, and that complications in this practice are low. METHODS: A prospective database of lung resections performed at an academic medical center between Jan 1, 2007 and Jan 1, 2017 was queried. Demographic and outcome variables were assessed using standard techniques. ED was defined as the length of stay (LOS) for the quintile with the lowest LOS for patients with anatomic resection (AR) or patients with wedge resection (WR). We then compared clinical factors between patients with ED to those patients discharged by day 7, to determine factors associated with ED (relative to "average" discharge). RESULTS: During the study period, there were 922 AR and 1,150 WR performed. A total of 448 (39.0%) patients had WRED and 211 patients (22.9%) had ARED. The rate of WRED varied by surgeon, but ARED did not. ARED and WRED patients was associated with several factors, including younger age, better lung function, and were less likely to have elevated American Society of Anesthesiologist (ASA) class. Multivariable analysis suggested that patient factors and primary surgeon influence ED. WRED was associated with 30-day mortality of 0.22% vs. 1.14% for longer LOS (P=0.08). After AR, there were no post-operative deaths within 30 days among 211 patients discharged on postoperative day 1 or 2 [(vs. 2/541, 0.4%, P=0.376) with longer LOS, P=0.048]. CONCLUSIONS: ED after lung resection is multifactorial but is safe among selected patients. Age, lung function, procedure duration, and surgeon all influence ED. Complications after ED were rare. Individual surgeon comfort with ED likely impacts LOS, and education or enhanced recovery protocols may help overcome this barrier. Standardized pathways would likely help identify low-risk patients for expeditious discharge.
BACKGROUND: The average hospitalization after lung resection is 6 days, but some patients are discharged early in the post-operative period. The patient factors associated with early discharge (ED) and the safety of this approach are unknown. We hypothesized that specific patient populations are associated with ED, and that complications in this practice are low. METHODS: A prospective database of lung resections performed at an academic medical center between Jan 1, 2007 and Jan 1, 2017 was queried. Demographic and outcome variables were assessed using standard techniques. ED was defined as the length of stay (LOS) for the quintile with the lowest LOS for patients with anatomic resection (AR) or patients with wedge resection (WR). We then compared clinical factors between patients with ED to those patients discharged by day 7, to determine factors associated with ED (relative to "average" discharge). RESULTS: During the study period, there were 922 AR and 1,150 WR performed. A total of 448 (39.0%) patients had WRED and 211 patients (22.9%) had ARED. The rate of WRED varied by surgeon, but ARED did not. ARED and WRED patients was associated with several factors, including younger age, better lung function, and were less likely to have elevated American Society of Anesthesiologist (ASA) class. Multivariable analysis suggested that patient factors and primary surgeon influence ED. WRED was associated with 30-day mortality of 0.22% vs. 1.14% for longer LOS (P=0.08). After AR, there were no post-operative deaths within 30 days among 211 patients discharged on postoperative day 1 or 2 [(vs. 2/541, 0.4%, P=0.376) with longer LOS, P=0.048]. CONCLUSIONS: ED after lung resection is multifactorial but is safe among selected patients. Age, lung function, procedure duration, and surgeon all influence ED. Complications after ED were rare. Individual surgeon comfort with ED likely impacts LOS, and education or enhanced recovery protocols may help overcome this barrier. Standardized pathways would likely help identify low-risk patients for expeditious discharge.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Subroto Paul; Nasser K Altorki; Shubin Sheng; Paul C Lee; David H Harpole; Mark W Onaitis; Brendon M Stiles; Jeffrey L Port; Thomas A D'Amico Journal: J Thorac Cardiovasc Surg Date: 2010-02 Impact factor: 5.209
Authors: Amin Madani; Julio F Fiore; Yifan Wang; Jimmy Bejjani; Lojan Sivakumaran; Juan Mata; Debbie Watson; Franco Carli; David S Mulder; Christian Sirois; Lorenzo E Ferri; Liane S Feldman Journal: Surgery Date: 2015-07-17 Impact factor: 3.982
Authors: Nadia A Khan; Hude Quan; Jennifer M Bugar; Jane B Lemaire; Rollin Brant; William A Ghali Journal: J Gen Intern Med Date: 2006-02 Impact factor: 5.128
Authors: Won Gi Jeong; Yun-Hyeon Kim; Jong Eun Lee; In-Jae Oh; Sang Yun Song; Kum Ju Chae; Hye Mi Park Journal: Cancer Res Treat Date: 2021-09-28 Impact factor: 5.036
Authors: Severin Schmid; Mohamad Kaafarani; Gabriele Baldini; Alexander Amir; Florin Costescu; Danielle Shafiepour; Jonathan Cools-Lartigue; Sara Najmeh; Christian Sirois; Lorenzo Ferri; David Mulder; Jonathan Spicer Journal: J Thorac Dis Date: 2021-11 Impact factor: 2.895