Factors influencing the length of stay after mediastinal tumor resection in the setting of an enhanced recovery after surgery (ERAS)-TUBELESS protocol

Shilong Wu; Jun Liu; Hengrui Liang; Yanzhi Ma; Yaoliang Zhang; Hui Liu; Hanyu Yang; Tuo Xin; Wenhua Liang; Jianxing He

doi:10.21037/atm-20-287

Factors influencing the length of stay after mediastinal tumor resection in the setting of an enhanced recovery after surgery (ERAS)-TUBELESS protocol

Ann Transl Med. 2020 Jun;8(12):740. doi: 10.21037/atm-20-287.

Authors

Shilong Wu¹, Jun Liu¹, Hengrui Liang¹, Yanzhi Ma², Yaoliang Zhang³, Hui Liu³, Hanyu Yang³, Tuo Xin¹, Wenhua Liang¹, Jianxing He¹

Affiliations

¹ Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
² Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
³ Guangzhou Medical University, Guangzhou, China.

Abstract

Background: Prolonged length of stay after surgery is considered to increase cost and hospital-acquired complications. Therefore, we aimed to identify the risk factors that were associated with an increased length of stay after mediastinal tumor resection in the setting of an enhanced recovery after surgery (ERAS)-TUBELESS protocol.

Methods: This prospective cohort study collected data on consecutive patients undergoing video-assisted thoracoscopic surgery (VATS) resection for mediastinal tumor between December 2015 and November 2018 at a single center in China. All patients followed the ERAS-TUBELESS protocol. A length of stay after VATS tumor resection (LOS) greater than 3 days was considered an increased LOS. Univariable and multivariable logistic regression models were used to identify potential factors associated with increased LOS. Factors were divided into patient-related risk factors and procedure-related risk factors.

Results: A total of 204 patients were included, of which 85 (41.67%) patients had a LOS of more than 3 days. The median LOS for the entire cohort was 3 days. All the patient-related risk factors had no significantly associated with a prolonged LOS. Procedure-related risk factors that were significantly associated with a prolonged LOS were surgeon, operation time, intraoperative blood loss, drainage tube, analgesic drugs, and complications. Anesthesia with spontaneous ventilation was correlated with early discharge (LOS ≤1 day).

Conclusions: In the setting of an ERAS-TUBELESS protocol, the main drivers of LOS were procedure-related factors. Anesthesia with spontaneous ventilation was associated with early discharge (LOS ≤1 day) and thus promoted thoracic day surgery.

Keywords: Length of hospital stay; enhanced recovery after surgery-TUBELESS (ERAS-TUBELESS); mediastinal tumor; video-assisted thoracoscopic surgery (VATS).