JTCVS Open (Apr 2024)

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

Journal volume & issue
Vol. 18
pp. 253 – 260

Abstract

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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.

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