Background: Utilizing our standardized approach to air leak reduction (STAR) protocol has led to a continual decrease in the need for inpatient recovery after lobectomy. Although next-day discharges do occur, the current literature, to our knowledge, has not addressed their safety. We analyzed our STAR data set to study this group and their outcomes. Methods: A retrospective review of prospectively collected data from the STAR data set was performed. Characteristics were compared between patients discharged on postoperative day (POD) 1 and those with longer admissions. Outcome data was analyzed. Results: From June 2010 through June 2017, 390 patients underwent lobectomy and met study criteria. Of these, 150 (38%) were discharged on POD 1 versus 240 (62%) who were discharged later (mean length of stay, 3.9 days). There was no increase in morbidity, mortality, or 30-day readmission between the 2 groups. Distinguishing characteristics of the POD 1 group included more nonsmokers, use of a minimally invasive technique, and a lower incidence of prolonged air leak. FEV1 (forced expiratory volume in 1 second) and DLCO (diffusing capacity of the lung for carbon monoxide) data were also favorable in the POD 1 group. The percentage of patients sent home POD 1 increased from an average of 23% over the first 3 years of the study to 63% over the last 3 years. Conclusions: Appropriately identified patients can safely go home on POD 1 after lobectomy without an increase in 30-day readmission, morbidity, or mortality. A continued focus on lobectomy length of stay reduction has the capacity to increase patient satisfaction and lead to reduction in health care costs.
Greer, S., Miller, A. D., Smith, J. S., Holcombe, J. M., & Headrick, J. R. (2018). Safety of Next Day Discharge After Lobectomy: Have We Broken the Speed Limit? Annals of Thoracic Surgery, 106(4), 998–1001. https://doi.org/10.1016/j.athoracsur.2018.05.034