Early and late readmissions after enhanced recovery thoracoscopic lobectomy

Huang, Lin; Frandsen, Mikkel Nicklas; Kehlet, Henrik; Petersen, René Horsleben

doi:10.1093/ejcts/ezac385

Cited by 7 publications

(2 citation statements)

References 29 publications

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“…Importantly, air leak was the main reason for reducing DAOH, as also shown after ERAS VATS lobectomy 15 . Furthermore, air leak was the main reason for prolonged hospitalization (27.7%) and for readmission (18.3%) following an established VATS lobectomy ERAS programme 5 , 19 . Thus, prevention of postoperative air leak is vital.…”

Section: Discussionmentioning

confidence: 99%

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Days alive and out of hospital after video-assisted thoracoscopic surgery wedge resection in the era of enhanced recovery

Huang,

Frandsen,

Kehlet

et al. 2023

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Background Days alive and out of hospital is proposed as a valid and patient-centred quality measure for perioperative care. However, no procedure-specific data exist after pulmonary wedge resection. The aim of this study was to assess the first 90 days alive and out of hospital after video-assisted thoracoscopic surgery wedge resection in an optimized enhanced recovery programme. Methods A retrospective analysis of prospectively collected data of consecutive patients undergoing enhanced recovery thoracoscopic wedge resections from January 2021 to June 2022 in a high-volume centre was carried out. All factors leading to hospitalization, readmission, and death were evaluated individually. A logistic regression model was used to evaluate predictors. Additionally, a sensitivity analysis was performed. Results A total of 433 patients were included (21.7% (n = 94) with non-small cell lung cancer, 47.6% (n = 206) with metastasis, 26.8% (n = 116) with benign nodules, and 3.9% (n = 17) with other lung cancers). The median duration of hospital stay was 1 day. The median of postoperative 30 and 90 days alive and out of hospital was 28 and 88 days respectively. Air leak (112 patients) and pain (96 patients) were the most frequent reasons for reduced days alive and out of hospital from postoperative day 1 to 30, whereas treatment of the original cancer or metastasis (36 patients) was the most frequent reason for reduced days alive and out of hospital from postoperative day 31 to 90. Male sex, reduced lung function, longer dimension of resection margin, pleural adhesions, and non-small cell lung cancer were independent risks, confirmed by a sensitivity analysis. Conclusion Days alive and out of hospital within 90 days after enhanced recovery thoracoscopic wedge resection was only reduced by a median of 2 days, mainly due to air leak and pain.

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Section: Discussionmentioning

confidence: 99%

“…Discharge criteria are self-mobilization, all lines and the chest drain removed, and no need for inpatient treatment. An X-ray is performed 2 h after removal of the chest drain and post-discharge management after VATS wedge resection is similar to that after VATS lobectomy 19 .…”

Section: Methodsmentioning

confidence: 99%

Days alive and out of hospital after video-assisted thoracoscopic surgery wedge resection in the era of enhanced recovery

Huang,

Frandsen,

Kehlet

et al. 2023

BJS Open

Self Cite

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Readmission after enhanced recovery video-assisted thoracoscopic surgery wedge resection

Huang,

Kehlet,

Petersen

2024

Surg Endosc

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Background Despite the implementation of Enhanced Recovery After Surgery (ERAS) programs, surgical stress continues to influence postoperative rehabilitation, including the period after discharge. However, there is a lack of data available beyond the point of discharge following video-assisted thoracoscopic surgery (VATS) wedge resection. Therefore, the objective of this study is to investigate incidence and risk factors for readmissions after ERAS VATS wedge resection. Methods A retrospective analysis was performed on data from prospectively collected consecutive VATS wedge resections from June 2019 to June 2022. We evaluated main reasons related to wedge resection leading to 90-day readmission, early (occurring within 0–30 days postoperatively) and late readmission (occurring within 31–90 days postoperatively). To identify predictors for these readmissions, we utilized a logistic regression model for both univariable and multivariable analyses. Results A total of 850 patients (non-small cell lung cancer 21.5%, metastasis 44.7%, benign 31.9%, and other lung cancers 1.9%) were included for the final analysis. Median length of stay was 1 day (IQR 1–2). During the postoperative 90 days, 86 patients (10.1%) were readmitted mostly due to pneumonia and pneumothorax. Among the cohort, 66 patients (7.8%) had early readmissions primarily due to pneumothorax and pneumonia, while 27 patients (3.2%) experienced late readmissions mainly due to pneumonia, with 7 (0.8%) patients experiencing both early and late readmissions. Multivariable analysis demonstrated that male gender, pulmonary complications, and neurological complications were associated with readmission. Conclusions Readmission after VATS wedge resection remains significant despite an optimal ERAS program, with pneumonia and pneumothorax as the dominant reasons. Early readmission was primarily associated with pneumothorax and pneumonia, while late readmission correlated mainly with pneumonia.

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Postoperative outcomes in patients with diabetes after enhanced recovery thoracoscopic lobectomy

Huang,

Petersen,

Kehlet

2024

Surg Endosc

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Background Diabetes is considered a general surgical risk factor, but with few data from enhanced recovery (ERAS) otherwise known to improve outcome. Therefore, this study aimed to investigate postoperative outcomes of patients with diabetes who underwent video-assisted thoracoscopic surgery (VATS) lobectomy in an established ERAS setting. Methods We retrospectively analysed outcome data (hospital stay (LOS), readmissions, and mortality) from a prospective database with consecutive unselected ERAS VATS lobectomies from 2012 to 2022. Complete follow-up was secured by the registration system in East Denmark. Results We included 3164 patients of which 323 had diabetes, including 186 treated with insulin and antidiabetic medicine, 35 with insulin only and 102 with antidiabetic medicine only. The median LOS was 3 days, stable over the study period. There were no differences in terms of LOS, postoperative complications, readmissions or 30 days alive and out of hospital. Patients with diabetes had significantly higher 30- and 90-day mortality rates compared to those without diabetes (p < .001), but also had higher preoperative comorbidity. Preoperative HbA1c levels did not correlate with postoperative outcomes. Conclusion In an ERAS setting, diabetes may not increase the risk for prolonged LOS, complications, and readmissions after VATS lobectomy, however with higher 30- and 90-day mortality probably related to more preoperative comorbidities.

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Early and late readmissions after enhanced recovery thoracoscopic lobectomy

Cited by 7 publications

References 29 publications

Days alive and out of hospital after video-assisted thoracoscopic surgery wedge resection in the era of enhanced recovery

Days alive and out of hospital after video-assisted thoracoscopic surgery wedge resection in the era of enhanced recovery

Readmission after enhanced recovery video-assisted thoracoscopic surgery wedge resection

Postoperative outcomes in patients with diabetes after enhanced recovery thoracoscopic lobectomy

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