Why do patients stay in hospital after enhanced recovery thoracoscopic wedge resection? A prospective observational study.

Abstract

This single-centre prospective observational study aimed to investigate reasons for prolonged hospitalization (over the median length of stay [LOS]) after enhanced recovery thoracoscopic (ERAS 3-port VATS) wedge resection. All patients were evaluated twice daily by an investigator for reasons of hospitalization. Each reason was analysed individually. Predictors for prolonged hospitalization were identified using a multivariable backward stepwise logistic regression model. A total of 150 consecutive patients (lymphadenectomy 8.7%) were included from November 2022 to December 2023, with a median LOS of 1 (interquartile range 1-2) day. Of these, 55 patients (36.7%) experienced prolonged hospitalization. The main reasons included postoperative pain (16.0%), air leak (14.7%), and social factors (14.7%), followed by oxygen dependency (7.3%), gastrointestinal factors (5.3%), urinary factors (4.7%), pneumonia (1.3%), pleural effusion (1.3%), chylothorax (0.7%), atrial fibrillation (0.7%), confusion (0.7%), and fatigue (0.7%). Multivariable analysis revealed that an increase in percentage of predicted forced expiratory volume in 1 second (FEV1%pre) by 1% (odds ratio [OR] 0.41, P = 0.023) and percentage of predicted diffusing capacity for carbon monoxide (DLCO%pre) by 1% (OR 0.95, P = 0.002) decreased likelihood of prolonged hospitalization. Conversely, each additional pack-year (OR 1.01, P = 0.028) and living alone (OR 3.55, P = 0.005) increased the risk of prolonged hospitalization. Prolonged hospitalization (LOS > 1 day) after ERAS 3-port VATS wedge resection, with 8.7% lymphadenectomy, was mainly due to pain, air leak, and social factors. Smokers with decreased FEV1%pre or DLCO%pre and patient living alone were at increased risk.