Comment on: Reasons for staying in hospital after video-assisted thoracoscopic surgery lobectomy.

Dear Editor

It was a pleasure to read the manuscript by Huang et al.[1] published in BJS Open, which focuses on exploring reasons for delayed patient discharge after video-assisted thoracoscopic lobectomy with a median length of hospital stay (LOS) of 2 days, as the author brings up excellent discussion topics.

Enhanced recovery after surgery (ERAS) is a multidisciplinary collaboration, multimodal coexistence, and evidence-based approach, which improves the nursing status of surgical patients by adopting a full range of optimized solutions in the perioperative interval to improve the quality of postoperative recovery and shorten the recovery time for the patient[2]. As shown by Huang et al., air leak was the most dominating factor for LOS greater than 2 days. From our own experience, if there is an obvious thoracic adhesion or complete atresia of the thoracic cavity during the operation, it will lead to serious postoperative air leakage. Second, lobectomy is associated with fewer air leaks than segmentectomy or even complex segmentectomy. In addition, we strongly agree with the authors that pulmonary tissue should be gently handled during the entire surgical procedure, as repeated lung clamping may result in severe contusions. It is well known that surgical trauma can lead to significant inflammatory and immune response disorders in the body, known as postoperative pulmonary complications (PPCs). PPCs are considered important negative influences on recovery outcomes, increasing LOS. In our study[3], we also explored the predictive factors for developing PPCs. In addition to the ERAS intervention, age, chronic obstructive pulmonary disease, and forced expiratory volume in 1 s can also significantly and independently predict the risk of developing PPCs and delaying discharge, which are the same results as shown in the authors’ study.