Safety analysis of video-assisted thoracic surgery in Day Care Unit and the risk factors for delayed discharge_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Lu ¹ , LU Ziyun ¹ , QIU Lihua ¹ , XU Huaye ¹ , WANG Tao ² , SHI Minke ² , MA Zhengliang ¹ ,  LI Bingbing ¹

1. Anesthesia Surgery Department, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, 210009, P. R. China;
2. General Thoracic Surgery Department, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, 210009, P. R. China;

Corresponding author：

LI Bingbing, Email: icecolor@163.com

Keywords：

Day surgery; video-assisted thoracic surgery; enhanced recovery after surgery; delayed discharge

DOI：

10.7507/1007-4848.202208040

Video：

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Objective To explore the perioperative safety of video-assisted thoracic surgery (VATS) in Day Care Unit and the risk factors for delayed discharge under centralized management model. Methods The patients with VATS managed by the Day Care Unit of the Drum Tower Hospital Affiliated to Nanjing University Medical School in 2021 were retrospectively collected. The patients’ postoperative data and risk factors for delayed discharge were analyzed. Results A total of 383 patients were enrolled, including 179 males and 204 females with an average age of 46.09±14.82 years. Eleven (2.87%) patients developed grade 3-4 postoperative complications during the hospitalization. Eighteen (4.70%) patients visited unscheduled outpatient clinic within 7 days, and 6 (1.57%) patients were re-hospitalized within 30 days after discharge. The remaining patients had no significant adverse events during the 30-day follow-up. The average length of hospital stay was 2.27±0.35 d. The length of hospital stay was over 48 h in 48 (12.53%) patients. The independent risk factor for delayed discharge was lobectomy or combined resection (OR=3.015, 95%CI 1.174-7.745, P=0.022). Conclusion VATS can be safely conducted under the centralized management in Day Care Unit. The risk factor for delayed discharge is the extent of surgical resection.

Citation： XU Lu, LU Ziyun, QIU Lihua, XU Huaye, WANG Tao, SHI Minke, MA Zhengliang, LI Bingbing. Safety analysis of video-assisted thoracic surgery in Day Care Unit and the risk factors for delayed discharge. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(4): 551-555. doi: 10.7507/1007-4848.202208040 Copy

1.	Tovar EA, Roethe RA, Weissig MD, et al. One-day admission for lung lobectomy: An incidental result of a clinical pathway. Ann Thorac Surg, 1998, 65(3): 803-806.
2.	Karcioglu O, Topacoglu H, Dikme O, et al. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med, 2018, 36(4): 707-714.
3.	Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis, 2014, 6(3): 271-284.
4.	Basse C, Chabanol H, Bonte PE, et al. Management of cutaneous toxicities under amivantamab (anti MET and anti EGFR bispecific antibody) in patients with metastatic non-small cell lung cancer harboring EGFR Exon20ins: Towards a proactive, multidisciplinary approach. Lung Cancer, 2022, 173: 116-123.
5.	Chung F, Chan VW, Ong D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth, 1995, 7(6): 500-506.
6.	陈安平, 龚明, 黎兰, 等. 日间快速康复模式下胸腔镜交感神经切断术治疗手汗症的单中心回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(3): 301-305.
7.	Hsia JY, Chen CY, Hsu CP, et al. Outpatient thoracoscopic sympathicotomy for axillary osmidrosis. Eur J Cardiothorac Surg, 2003, 24(3): 425-427.
8.	董映显, 朱道君, 车国卫, 等. 肺癌日间手术操作流程与临床应用效果分析. 中国肺癌杂志, 2020, 23(2): 77-83.
9.	蒋丽莎, 詹丽莉, 沈诚, 等. 日间手术模式下胸腔镜手术治疗肺结节的安全性分析. 华西医学, 2020, 35(2): 152-155.
10.	Gaudet MA, D'Amico TA. Thoracoscopic lobectomy for non-small cell lung cancer. Surg Oncol Clin N Am, 2016, 25(3): 503-513.
11.	Cohen C, Al Orainy S, Pop D, et al. Anatomical pulmonary resections for primary lung cancer in octogenarians within a dedicated care protocol. J Thorac Dis, 2019, 11(9): 3732-3737.
12.	Sancheti MS, Chihara RK, Perez SD, et al. Hospitalization costs after surgery in high-risk patients with early stage lung cancer. Ann Thorac Surg, 2018, 105(1): 263-270.
13.	Yao X, Zheng D, Yuan C, et al. Comparison of perioperative and survival outcomes between sublobar resection and lobectomy of patients who underwent a second pulmonary resection. Thorac Cancer, 2021, 12(17): 2375-2381.
14.	Matsubara T, Toyokawa G, Kinoshita F, et al. Safety of simultaneous bilateral pulmonary resection for metastatic lung tumors. Anticancer Res, 2018, 38(3): 1715-1719.
15.	Huang C, Sun Y, Wu Q, et al. Simultaneous bilateral pulmonary resection via single-utility port VATS for multiple pulmonary nodules: A single-center experience of 16 cases. Thorac Cancer, 2021, 12(4): 525-533.
16.	Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: Post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med, 2018, 6(12): 915-924.

1. Tovar EA, Roethe RA, Weissig MD, et al. One-day admission for lung lobectomy: An incidental result of a clinical pathway. Ann Thorac Surg, 1998, 65(3): 803-806.
2. Karcioglu O, Topacoglu H, Dikme O, et al. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med, 2018, 36(4): 707-714.
3. Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis, 2014, 6(3): 271-284.
4. Basse C, Chabanol H, Bonte PE, et al. Management of cutaneous toxicities under amivantamab (anti MET and anti EGFR bispecific antibody) in patients with metastatic non-small cell lung cancer harboring EGFR Exon20ins: Towards a proactive, multidisciplinary approach. Lung Cancer, 2022, 173: 116-123.
5. Chung F, Chan VW, Ong D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth, 1995, 7(6): 500-506.
6. 陈安平, 龚明, 黎兰, 等. 日间快速康复模式下胸腔镜交感神经切断术治疗手汗症的单中心回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(3): 301-305.
7. Hsia JY, Chen CY, Hsu CP, et al. Outpatient thoracoscopic sympathicotomy for axillary osmidrosis. Eur J Cardiothorac Surg, 2003, 24(3): 425-427.
8. 董映显, 朱道君, 车国卫, 等. 肺癌日间手术操作流程与临床应用效果分析. 中国肺癌杂志, 2020, 23(2): 77-83.
9. 蒋丽莎, 詹丽莉, 沈诚, 等. 日间手术模式下胸腔镜手术治疗肺结节的安全性分析. 华西医学, 2020, 35(2): 152-155.
10. Gaudet MA, D'Amico TA. Thoracoscopic lobectomy for non-small cell lung cancer. Surg Oncol Clin N Am, 2016, 25(3): 503-513.
11. Cohen C, Al Orainy S, Pop D, et al. Anatomical pulmonary resections for primary lung cancer in octogenarians within a dedicated care protocol. J Thorac Dis, 2019, 11(9): 3732-3737.
12. Sancheti MS, Chihara RK, Perez SD, et al. Hospitalization costs after surgery in high-risk patients with early stage lung cancer. Ann Thorac Surg, 2018, 105(1): 263-270.
13. Yao X, Zheng D, Yuan C, et al. Comparison of perioperative and survival outcomes between sublobar resection and lobectomy of patients who underwent a second pulmonary resection. Thorac Cancer, 2021, 12(17): 2375-2381.
14. Matsubara T, Toyokawa G, Kinoshita F, et al. Safety of simultaneous bilateral pulmonary resection for metastatic lung tumors. Anticancer Res, 2018, 38(3): 1715-1719.
15. Huang C, Sun Y, Wu Q, et al. Simultaneous bilateral pulmonary resection via single-utility port VATS for multiple pulmonary nodules: A single-center experience of 16 cases. Thorac Cancer, 2021, 12(4): 525-533.
16. Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: Post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med, 2018, 6(12): 915-924.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Safety analysis of video-assisted thoracic surgery in Day Care Unit and the risk factors for delayed discharge

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