Length of Stay after Minimally Invasive Lung Cancer Resection Utilizing T-ERAS Protocol is Decreased Compared to NSQIP Surgical Risk Calculator Predictions
J. Park1, D. Pham2, K. Nilsson2, L. Ramsey2, H. Harrelson2, S. Twardus2, D. Morris2, S. Khandhar3, M. Weyant4, K. Suzuki5 1Inova Health System, Fairfax, Virginia 2Inova Health System, Falls Church, Virginia 3Virginia Cancer Specialists, Fairfax, Virginia 4INOVA, Fairfax, Virginia 5Inova, Falls Church, Virginia
Resident Inova Health System Fairfax, Virginia, United States
Disclosure(s):
Ju Ae Park, MD: No financial relationships to disclose
Purpose: Thoracic Enhanced Recovery with Ambulation after Surgery (T-ERAS) protocol at our institution includes ambulation into OR, narcotics minimization, and 250-feet ambulation within 1 hour of extubation. Our goal was to compare the average length of stay (LOS) between T-ERAS and that which is predicted using a validated surgical risk calculator. Methods: We performed a retrospective chart review of patients who underwent lung cancer resection with minimally invasive approach (video-assisted thoracoscopic surgery or robot-assisted) from 2012 to 2022. Patients aged 18 and older were included if early ambulation was documented in the medical record. LOS was defined as the number of calendar days in the hospital based on admission and discharge dates. Patient demographics (age, height, weight), co-morbidities (chronic obstructive pulmonary disease, hypertension, congestive heart failure, diabetes, systemic steroid use, smoking status, dialysis), American Society of Anesthesiologists classification, and the CPT code for primary surgical procedure were collected and entered into the American College of Surgeons’ National Surgical Quality Improvement Program Risk Calculator (NSQIP) to obtain the predicted length of stay (1/10th place rounded up). Descriptive statistics, comparisons of observed vs. predicted length of stay (O/P ratio), and non-parametric testing were conducted. Results: Of the 979 patients reviewed, 886 met eligibility. The study group demographics were average age of 68 years, 514 (58.0%) female, and 220 (75.1%) did not smoke in the prior year. Majority of patients were pathologic stage I (n=575, 64.9%). By procedure, there were 631 (71.2%) lobectomies, 204 (23.0%) wedges, 26 (2.9%) segmentectomies, 20 (2.3%) bilobectomies, and 5 (0.6%) pneumonectomies. The average LOS observed for the entire cohort was 1.2 days (median 1.0 day, maximum 15 days, Table 1) compared to the predicted LOS of 3.4 days with the NSQIP (median 4.0, maximum 7 days). Overall, 842 (95%) patients had LOS better than predicted (O/P ratio < 1), 19 (2.1%) had LOS as predicted (O/P ratio =1), and 25 (2.8%) had LOS longer than predicted (O/P ratio >1). The mean O/P ratio was 0.34. Stratified by procedure, patients receiving lobectomy had an average observed LOS of 1.4 days (median 1.0 day) while patients who had wedge/multiple wedge resections were discharged the same day as surgery (average =0.5 days; median =0, p< 0.001). The total number of postoperative complications were 47 (5.3%) readmissions, 40 (4.6%) prolonged air leak, 40 (4.5%) arrhythmia, 12 (1.4%) acute kidney injury, 7 (0.8%) pneumonia, and 2 (0.2%) death. Conclusion: The average LOS with T-ERAS protocol was 1.2 days compared to the predicted average of 3.6 days in patients undergoing minimally invasive lung cancer resections. Our study provides a potential protocol to shorten the LOS beyond what is predicted by NSQIP.
Identify the source of the funding for this research project: No funding utilized
