Postoperative day 1 discharge after anatomic lung resection: A Society of Thoracic Surgeons database analysis

J Thorac Cardiovasc Surg. 2020 Feb;159(2):667-678.e2. doi: 10.1016/j.jtcvs.2019.08.038. Epub 2019 Sep 13.

Abstract

Objective: Although minimally invasive techniques have led to shorter hospitalizations, discharge on postoperative day 1 is still uncommon. We hypothesized that day 1 discharge could be performed safely and that there might be significant variation in day 1 discharge rates between hospitals.

Methods: We identified patients with lung cancer who underwent lobectomy and segmentectomy in the Society of Thoracic Surgeons Database from 2012 to 2017. The 10% longest hospital stay outliers were excluded. A multivariable regression model was created to assess for factors associated with day 1 discharge and readmission.

Results: A total of 46,325 patients were examined, and 1821 patients (3.9%) were discharged on day 1. This rate increased from 3.4% to 5.3% over the course of the study (P < .0001). In multivariable analysis, factors associated with day 1 discharge included age, Zubrod score, body mass index greater than 25, forced expiration value at 1 second, middle or upper lobectomy, minimally invasive technique, and procedure time. Outpatient 30-day mortality was similar (0.3% vs 0.4%, P = .472). Patients discharged on day 1 were not at increased risk of readmission. Readmission after day 1 discharge was associated with male sex, coronary artery disease, chronic obstructive pulmonary disease, and longer procedure time. There was substantial variation in day 1 discharge rate between institutions, with 11 centers (4.0%) discharging more than 20% of their patients on day 1, whereas 102 centers (36.7%) had no day 1 discharges.

Conclusions: Day 1 discharge after anatomic lung resection is uncommon but is becoming more common. Carefully selected patients may be discharged on day 1 without an increased risk of readmission or death.

Keywords: length of stay; patient discharge; postoperative complications; risk factors; thoracic surgery.

MeSH terms

  • Aged
  • Female
  • Humans
  • Length of Stay / statistics & numerical data*
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Patient Discharge / statistics & numerical data*
  • Patient Readmission
  • Pneumonectomy* / adverse effects
  • Pneumonectomy* / mortality
  • Pneumonectomy* / statistics & numerical data
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Risk Factors