MA15.03 Social Factors Influencing the Length of Stay in Hospital After Anatomical Resection

Abstract

Length of stay in hospital (LOS) is investigated in most surgical studies as quality of care measure. It represents a surrogate of procedures efficacy and safety, and it is used to compare operations or techniques. However, most studies take into consideration only clinical factors that might impair the post-operative course prolonging the LOS. The associations between social factors and post-operative outcomes is known, but not considered. We wanted to investigate whether social factors influence the LOS after anatomical lung resections for lung cancer, incorporating these non-clinical variables with established confounders, among complicated and non-complicated patients. Partial results of the study are presented at the 2021 European Society of Thoracic Surgeons meeting. Prospectively maintained databases on anatomical lung resections for lung cancer from two national centers, were retrospectively culled for data (January 2017-March 2021). Along with clinical factors (sex, age, performance status, FEV1, DLCO smoking status, Charlson Comorbidity Index, body mass index, surgical access, intercostal tube duration, complications), three social variables were included: living alone, place of discharge, educational level. Multiple linear regression analysis was used to determine variables that contributed to prolong LOS. Subgroup analyses were performed based on post-operative complications. 328 consecutive patients were included. 273 lobectomies, 12 bilobectomies, 37 segmentectomies and 6 pneumonectomies were performed. Median LOS was 6 days (IQR:4-9). 119 patients (36.3%) experienced at least 1 complication (1 to 5 grade according to the Thoracic Morbidity and Mortality system). 107 patients (32.6%) lived alone, 74 (22.6%) were not discharged home (rehabilitations or other acute departments), 137 (41.8%) had an educational level below secondary school. FEV1 (p=0.004), chest tube duration (p<0.0001), performance status (p=0.01), surgical access (p<0.0001), presence of complications (p<0.0001), living alone (p=0.001) and place of discharge (p<0.0001) significantly influenced LOS. In the complicated group, FEV1 (p=0.001), intercostal tube duration (p=0.02), place of discharge (0.006) and living alone (p=0.03) were factors associated with LOS. In the non-complicated group, performance status (p=0.001), open approach (p<0.0001), intercostal tube duration (p<0.0001), place of discharge (p<0.0001) and living alone (p=0.01) remained associated with LOS. Social factors influence LOS after anatomical lung resections for lung cancer. LOS itself does not merely correspond to the effectiveness of surgical procedures, and its use as surrogate of quality of care should be carefully interpreted. Moreover, these results suggest the need for closer examination of patients background, anticipation and enhancement of post-surgical care (rehabilitation facilities) and may help directing health care investments in this sense.