Intersurgeon variations in postoperative length of stay after video-assisted thoracoscopic surgery lobectomyCentral MessagePerspective
Jonathan Zini,
Gabriel Dayan, MD,
Maxime Têtu,
Toni Kfouri,
Luciano Bulgarelli Maqueda, MD,
Elias Abdulnour, MD,
Pasquale Ferraro, MD,
Pierre Ghosn, MD,
Edwin Lafontaine, MD,
Jocelyne Martin, MD,
Basil Nasir, MD,
Moishe Liberman, MD, PhD
Affiliations
Jonathan Zini
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Gabriel Dayan, MD
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Maxime Têtu
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Toni Kfouri
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Luciano Bulgarelli Maqueda, MD
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Elias Abdulnour, MD
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Pasquale Ferraro, MD
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Pierre Ghosn, MD
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Edwin Lafontaine, MD
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Jocelyne Martin, MD
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Basil Nasir, MD
Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Moishe Liberman, MD, PhD
Address for reprints: Moishe Liberman, MD, PhD, Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, 900 rue Saint-Denis, Room R04:402-1, Montreal, Québec H2X 0A9, Canada.; Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Québec, Canada
Objectives: To identify factors associated with prolonged postoperative length of stay (LOS) after VATS lobectomy (VATS-L), explore potential intersurgeon variation in LOS and ascertain whether or not early discharge influences hospital readmission rates. Methods: We conducted a retrospective analysis of patients who underwent VATS-L at a single academic center between 2018 and 2021. Each VATS lobectomy procedure was performed by 1 of 7 experienced thoracic surgeons. The primary end point of interest was prolonged LOS, defined as an index LOS >3 days. Results: Among 1006 patients who underwent VATS lobectomy, 632 (63%) had a prolonged LOS. On multivariate analysis, the factors independently associated with prolonged LOS were: surgeon (P 3, and prior ipsilateral thoracic surgery or sternotomy. There was no association between LOS ≤3 days and hospital readmission (20 [5.3%] vs 39 [5.9%]; OR, 0.88; 95% CI, 0.50-1.53). Conclusions: An intersurgeon variation in postoperative LOS after VATS-L exists and is independent of patient baseline characteristics or perioperative complications. This variation seems to be more closely related to differences in postoperative management and discharge practices rather than to surgical quality. Postoperative discharge within 3 days is safe and does not increase hospital readmissions.
