Safety of Next Day Discharge After Lobectomy: Have We Broken the Speed Limit?

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Abstract

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.

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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

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