Wildfire exposures and in-hospital length of stay following lung cancer surgery.

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311 Background: Wildfires pose substantial health and safety threats to patients recovering from lung cancer surgery. Without specific disaster preparedness guidelines, oncologists might resort to improvisational strategies, such as increasing the length of stay (LOS), a federal care quality measure with financial implication for hospitals, to better protect the health and safety of this medically vulnerable population. Methods: Individuals aged ≥18 years who received curative-intent lobectomy or pneumonectomy for stage I-III NSCLC between 2004 and 2021 were selected from the National Cancer Database. Exposure was defined as a Federal Emergency Management Agency (FEMA) Presidential Disaster Declaration in the county of the treatment facility between date of surgery and date of discharge from the hospital. Differences in the cumulative distribution function of LOS, defined as days between date of surgery and date of discharge from the hospital, were evaluated between exposed and propensity score matched unexposed patients, who were treated at the same facility but at a time when no disasters occurred, using the product-limit method and log-rank test. In sensitivity analysis, patients with discharge date equal to date of death (in-hospital mortality) were excluded, and the association was evaluated stratified by stage. Results: Patients exposed to a wildfire disaster declaration in the county of the treating facility had longer LOS (p<0.001) than unexposed patients (9.4days compared to 7.5 days, respectively) overall and for each of the stages (I-III) for which surgery is the recommended treatment modality. In sensitivity analysis, there were no in-hospital mortality difference between exposed and unexposed patients (10.8% and 10.5%, respectively, p=0.76). Excluding patients who died in the hospital did not change the main results. Conclusions: Patients whose facility is impacted by a wildfire disaster during recovery from lung cancer surgery have longer length of stay than similar patients treated at the same facility but at times when no disaster occurred. Future studies should evaluate whether extended hospital stay improves safety and quality of surgical care. Moreover, these findings should be considered for disaster preparedness guidelines tailored to vulnerable patient population.