Factors Associated With Inappropriate Hospital Stay After Uncomplicated Resection of c-Stage I Non-Small-Cell Lung Cancer. A Single Center Study.

Abstract

Inappropriate hospital stay increases healthcare costs and creates daily problems with bed availability. It may occur due to overemphasis on minor postoperative symptoms, and/or overly prudent attitude of attending surgeons. In this study, we sought to analyze predictors of inappropriate hospital stay in patients undergoing uncomplicated major resection for c-stage I non-small cell lung cancer. A total of 216 patients were reviewed. For each patient, surgical risk profile and predicted hospital stay were calculated according to the American College of Surgeons-National Surgical Quality Improvement Project score (ACS-NSQIP) system. Theoretically inappropriate stay (TIS) was defined as the difference between predicted and actual hospital stay. Actual inappropriate stay (AIS) was the difference between actual hospital stay and the time when discharge criteria were met, according to the Appropriateness Evaluation Protocol. Hospital stay, TIS, and AIS, were subjected to linear- and quantile regression analysis to find association with predictor variables including surgical approach (uni- and multiportal VATS, RATS, hybrid), extent of resection, and others. Mean hospital stay length was 5.0 ± 1.6 days. Seventy-seven patients (19.9%) experienced minor postoperative symptoms, whereas 139 (80.1%) had completely uneventful recovery. TIS and AIS were 1.22 ± 1.4 and 1.25 ± 0.9 days respectively (0.82 ± 1.32 and 1.1 ± 0.9 after uneventful recovery). TIS and AIS ≥ 1 day were reported in 72.2% and 74.5% of patients, respectively. At multivariable analysis, surgical risk profile (p = 0.002), surgical approach (p = 0.009) and extent of resection (p < 0.001) were associated with hospital stay length. Furthermore, extent of resection was strongly associated with both TIS/AIS and was the strongest independent predictor of AIS (p = 0.02). Quantile regression showed that patients with ≤ 2 functional segments removed were > 75% likely to have AIS 1 day shorter than others. Inappropriate hospital stay was reported in a relatively high number of patients undergoing uncomplicated resection for c-stage I NSCLC. Our results might serve as a benchmark for future improvements and implementation of more efficient discharge strategies in thoracic surgery. Sublobar resection might also help optimize hospital stay, when oncologically appropriate.