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

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.

Automated summary

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.