Early Discharge Does Not Increase Readmission Rates After Minimally Invasive Anatomic Lung Resection

Chevrollier, Guillaume S.; Nemecz, Amanda; Devin, Courtney L.; Go, Kendrick V.; Yi, Misung; Keith, Scott W.; Cowan, Scott W.; Evans, Nathaniel R.

doi:10.1177/1556984519836821

Cited by 5 publications

(10 citation statements)

References 26 publications

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“…Forster et al also showed no difference in 30‐day readmission between patients discharged within 3 days and those discharged after 3 days in thoracoscopic anatomic lung cancer surgery 15 . Even among patients treated with the enhanced recovery pathway, Chevrollieret al concluded that discharge within 2 days after minimally invasive anatomic lung resection did not increase the risk of readmission 10 …”

Section: Resultsmentioning

confidence: 99%

“…Early discharge has different definitions and criteria in various documents, without a specific minimum postoperative stay 8–11,15,16 . Currently, the most frequently used date of early discharge was 2 days or 1 day after surgery.…”

Section: Resultsmentioning

confidence: 99%

“…15 Even among patients treated with the enhanced recovery pathway, Chevrollieret al concluded that discharge within 2 days after minimally invasive anatomic lung resection did not increase the risk of readmission. 10 This retrospective study has several limitations. First, as a retrospective study based on prospectively collected data, it has the inherent design biases.…”

Section: Commentsmentioning

confidence: 98%

“…[4][5][6] Evolving management after thoracoscopic surgery has accelerated the discharge process for patients, some researches have even proposed a specific minimum hospitalization 7,8 and believe that this approach might be associated with improved outcomes. [8][9][10] However, many thoracic surgeons remain reluctant to perform early discharge for fear that it may prevent adequate and timely detection and management of complications, leading to an increase in 30-day readmission rate. 11,12 Moreover, readmission is a critically scrutinized indicator of the quality for primary care in hospitals and also associated with substantial costs that may offset any financial benefits gained from previously early discharge.…”

Section: Introductionmentioning

confidence: 99%

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Analysis for discharge within 2 days after thoracoscopic anatomic lung cancer surgery

Chen

Ren

et al. 2023

Cancer Medicine

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Objectives:The risk and beneficial factors of early discharge after thoracoscopic anatomic lung cancer surgery are unknown, and this study aims to investigate predictors and associated 30-day readmission for early discharge. Methods:We performed a single-center retrospective analysis of 10,834 consecutive patients who underwent thoracoscopic anatomic lung cancer surgery. Two groups were determined based on discharge date: "discharged by postoperative Day 2" and "discharged after postoperative Day 2." Univariable and multivariable analysis were conducted to identify predictors for discharge. Using propensity score matching (PSM) to compare 30-day readmission rate between two cohorts.Results: A total of 1911 patients were discharged by postoperative Day 2.Multivariable analysis identified older age (odds ratio (OR) = 1.014, p < 0.001), male sex (OR = 1.183, p = 0.003), larger tumor size (OR = 1.248, p < 0.001), pleural adhesions (OR = 1.638, p = 0.043), lymph nodes calcification (OR = 1.443, p = 0.009), advanced clinical T stage (vs. T < 2, OR = 1.470, p = 0.010), lobectomy resection (vs. segmentectomy resection, OR = 2.145, p < 0.001) and prolonged operative time (OR = 1.011, p < 0.001) as independent risk factors for discharge after postoperative Day 2. Three adjustable variables including higher FEV 1 / FVC (OR = 0.989, p = 0.001), general anesthesia (GA) plus thoracic paravertebral blockade (vs. GA alone, OR = 0.823, p = 0.006) and uni-portal thoracoscopic surgery (vs. multi-portal, OR = 0.349, p < 0.001) were associated with a decreased likelihood of discharge after postoperative Day 2. Before and after a 1:1 PSM, discharged by postoperative Day 2 did not increase the risk of 30-day readmission compared to counterparts. Conclusions:Carefully selected patients can be safely discharged within 2 days after thoracoscopic anatomic lung cancer surgery. Three modifiable variables may be favorable for promoting discharge by postoperative Day 2.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Commentsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Analysis for discharge within 2 days after thoracoscopic anatomic lung cancer surgery

Chen

Ren

et al. 2023

Cancer Medicine

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“…A number of published studies have supported early discharge practice. Early discharge after lung cancer resection, 1,2 colorectal resections for benign and malignant disease, 3–5 and high-risk thoracic vascular operations 6 did not result in an increase in readmission rates. Similarly, early discharge was not associated with an increase in readmission among a generalized hepato-pancreato-biliary surgery weighted patient cohort.…”

mentioning

confidence: 88%

Early Patient Discharge in Selected Patients is Not Associated With Higher Readmission After Major Abdominal Operations

et al. 2020

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Objective: Our objective was to examine the associations between early discharge and readmission after major abdominal operations. Background: Advances in patient care resulted in earlier patient discharge after complex abdominal operations. Whether early discharge is associated with patient readmissions remains controversial. Methods: Patients who had colorectal, liver, and pancreas operations abstracted in 2011-2017 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files were included. Patient readmission was stratified by 6 operative groups. Patients who were discharged before median discharge date within each operative group were categorized as an early discharge. Analyses tested associations between early discharge and likelihood of 30-day postoperative unplanned readmission. Results: A total of 364,609 patients with major abdominal operations were included. Individual patient groups and corresponding median day of discharge were: laparoscopic colectomy (n = 152,575; median = 4), open colectomy (n =137,462; median = 7), laparoscopic proctectomy (n = 12,238; median = 5), open proctectomy (n = 24,925; median = 6), major hepatectomy (n = 9,805; median = 6), pancreatoduodenectomy (n = 27,604; median = 8). Early discharge was not associated with an increase in proportion of readmissions in any operative group. Early discharge was associated with a decrease in average proportion of patient readmissions compared to patients discharged on median date in each of the operative groups: laparoscopic colectomy 6% versus 8%, open colectomy 11% versus 14%, laparoscopic proctectomy 13% versus 16%, open proctectomy 13% vs 17%, major hepatectomy 8% versus 12%, pancreatoduodenectomy 16% versus 20% (all P ≤ 0.02). Serious morbidity composite was significantly lower in patients who were discharged early than those who were not in each operative group (all P < 0.001). Conclusions: Early discharge in selected patients after major abdominal operations is associated with lower, and not higher, rate of 30-day unplanned readmission.

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Early discharge after thoracoscopic anatomical pulmonary resection for non-small-cell lung cancer

Forster

Perentes

Ojanguren

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Although video-assisted thoracic surgery (VATS) has shortened hospitalization duration for non-small-cell lung cancer (NSCLC) patients, the factors associated with early discharge remain unclear. This study aimed to identify patients eligible for a 72-h stay after VATS anatomical resection. METHODS Monocentric retrospective study including all consecutive patients undergoing VATS anatomical resection for NSCLC between February 2010 and December 2019. Two groups were defined according to the discharge: ‘early discharge’ (within 72 postoperative hours) and ‘routine discharge’ (at >72 postoperative hours). RESULTS A total of 660 patients with a median age of 66.5 years (interquartile range 60–73 years) (female/male: 321/339) underwent VATS anatomical pulmonary resection for NSCLC [segmentectomy in 169 (25.6%), lobectomy in 481 (72.9%), bilobectomy in 8 (1.2%) and pneumonectomy in 2 (0.3%) patients]. The cardiopulmonary and Clavien–Dindo III–IV postoperative complication rates were 32.6% and 7.7%, respectively. The median postoperative length of stay was 6 days (interquartile range 4–10 days). In total, 119 patients (18%) could be discharged within 72 h of surgery. On multivariable analysis, the factors significantly associated with an increased likelihood of early discharge were: body mass index >20 kg/m2 [odds ratio (OR) 2.37], absence of prior cardiopathy (OR 2), diffusing capacity of the lung for carbon monoxide >60% (OR 1.82), inclusion in an enhanced recovery after surgery protocol (OR 2.23), use of a single chest tube (OR 5.73) and postoperative transfer to the ward (OR 4.84). Factors significantly associated with a decreased likelihood of early discharge were: age >60 years (OR 0.53), American Society of Anaesthesiologists score >2 (OR 0.46) and use of an epidural catheter (OR 0.41). Readmission rates were not statistically different between both groups (5.9% vs 3.1%; P = 0.17). CONCLUSIONS Age, pulmonary functions and comorbidities may influence discharge after VATS anatomical resection. The early discharge does not increase readmission rates.

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Early Discharge Does Not Increase Readmission Rates After Minimally Invasive Anatomic Lung Resection

Cited by 5 publications

References 26 publications

Analysis for discharge within 2 days after thoracoscopic anatomic lung cancer surgery

Analysis for discharge within 2 days after thoracoscopic anatomic lung cancer surgery

Early Patient Discharge in Selected Patients is Not Associated With Higher Readmission After Major Abdominal Operations

Early discharge after thoracoscopic anatomical pulmonary resection for non-small-cell lung cancer

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