VALUE Trial: Phase 1 safety and feasibility study of same-day discharge after video-assisted thoracoscopic surgery lung resection.

Abstract

Although Enhanced Recovery After Surgery programs are becoming more prevalent in thoracic surgery, minimal prospective research exists for same-day discharge after lung resection. Thus, this trial aimed to evaluate the safety and feasibility of same-day discharge after video-assisted thoracoscopic surgery. This phase 1 registered trial (NCT05583916) enrolled patients from a single institution who were candidates for a video-assisted thoracoscopic surgery anatomic or wedge resection to treat confirmed or suspected lung malignancy. After preoperative education, patients were discharged home with a chest tube connected to a mini-atrium. Patients returned 1 to 3 days later for evaluation of chest tube removal. Quality of life was assessed using the Functional Assessment of Cancer Therapy - Lung and Edmonton Symptom Assessment Scale questionnaires. Descriptive statistics were conducted for clinical outcomes, and univariant t test analyzed quality of life data. Twenty-one patients (n = 16; 76% female) were enrolled. The mean age was 65 years with 12 (57%) past or current smokers. Staging was 88% (n = 15) with stage I, 12% (n = 2) with stage II, and 19% (n = 4) with metastasis to the lung. Two patients withdrew their consent; the remaining 19 patients underwent video-assisted thoracoscopic surgery lobectomy (n = 9), segmentectomy (n = 4), or wedge (n = 6). Same-day discharge was achieved in 95% of cases (n = 18). Median chest tube duration was 2 days (range of values, 1-10). One emergency department visit occurred. Two grade 2 prolonged air leaks occurred with no grade 3 to 5 adverse events. Quality of life data did not significantly differ from a standard-of-care cohort (n = 151). Same-day discharge after video-assisted thoracoscopic surgery lung resections appears safe and feasible for carefully selected patients with planned anatomic or nonanatomic resections.