4.6 Article

Video-assisted thoracoscopic treatment as two-day surgery for lung neoplasms: a propensity-matched analysis

Journal

BMC CANCER
Volume 22, Issue 1, Pages -

Publisher

BMC
DOI: 10.1186/s12885-022-09938-x

Keywords

Thoracic surgery; Video-assisted; Enhanced recovery after surgery; Lung neoplasms; Postoperative complications; Propensity matching

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Funding

  1. Excellence in Surgery Grant of the Wu Jieping Medical Foundation [ESGWJP2017]

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The two-day surgery for lung neoplasms is a safe, feasible, and cost-effective procedure that can reduce hospital stays and costs, as well as lower the incidence of postoperative complications.
Background Enhanced recovery after surgery programs have reduced complications and shortened hospital stays after lung resection. This study aimed to determine whether video-assisted thoracoscopic surgery performed as a two-day surgery for lung neoplasms was safe and cost-effective. Methods This retrospective, propensity-matched, cohort analysis was conducted from January 2020 to August 2020. Among 959 patients who underwent video-assisted thoracoscopic surgery, 739 underwent inpatient surgery and 220 underwent two-day surgery. Propensity-matched analysis, incorporating preoperative variables, was used to compare postoperative complications, post-discharge follow-up results, and hospitalization costs between the groups. Results Propensity matching estimated 218 patients in each group. The mean length of hospital stay was shorter in the two-day surgery group (2.17 +/- 0.89 days) than in the inpatient surgery group (6.31 +/- 2.13 days) (P < 0.001). Delayed removal of chest tubes accounted for over half of the delayed discharges in the inpatient (17 [54.8%]) and two-day surgery (13 [65.0%]) groups. The postoperative pneumonia/atelectasis incidence was lower in the two-day surgery group than in the inpatient surgery group (P = 0.032). The two-day surgery group patients were readmitted to the hospital due to massive pleural effusion, pneumothorax, fever, severe chest pain, and physical weakness. The mean total hospitalization cost in the two-day surgery group was lower than that in the inpatient surgery group ( yen 33,926.1 versus yen 38,422.7, P < 0.001). Basic medical, nursing, drug, laboratory-related, and nonsurgical consumable costs in the two-day surgery group were significantly reduced. Conclusions Two-day surgery is a safe, feasible, and cost-effective procedure for selected patients with lung neoplasms when combined with accurate preoperative evaluations, successful intraoperative assessments, and effective postoperative health care guidance.

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