Rapid Discharge After Anatomic Lung Resection: Is Ambulatory Surgery for Early Lung Cancer Possible?

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Resource constraints during the COVID-19 pandemic prompted an investigation into rapid discharge protocols.
• Early-stage lung cancer patients undergoing minimally invasive procedures were assessed for early discharge feasibility.

Purpose of the Study:

• To determine if minimally invasive anatomic lung resections for early-stage lung cancer could be safely discharged rapidly.
• To evaluate the impact of rapid discharge on inpatient resource utilization and patient outcomes.

Main Methods:

• A retrospective review of 430 patients with clinical stage I-II non-small cell lung cancer who underwent minimally invasive anatomic resection.
• Patients discharged within 18 hours without a chest tube were classified as rapid discharge.
• Comparison of demographics, comorbidities, operative details, and 30-day outcomes between rapid discharge and control groups.
• Multivariable logistic regression identified predictors of non-rapid discharge.

Main Results:

• 37% of patients (162/430) met rapid discharge criteria.
• Rapid discharge patients were younger, had lower American Society of Anesthesiologists class, underwent more segmentectomies, and had smaller tumors.
• No significant differences in distance to hospital or 30-day readmission rates were observed between groups.
• Increasing age was associated with higher odds of non-rapid discharge (OR 1.04), while segmentectomy was associated with decreased odds (OR 0.46).

Conclusions:

• Rapid discharge is feasible for a significant proportion of early-stage lung cancer patients undergoing minimally invasive resection.
• Segmentectomy and younger age are favorable factors for rapid discharge.
• Implementing rapid discharge strategies can reduce inpatient resource utilization without compromising patient safety or increasing readmissions.