Factors Associated with Post-Operative Day (POD)? 1 Discharge Following Minimally-Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer (NSCLC) - A National Cancer Database (NCDB) Analysis
Mirza Zain Baig1, Syed Shahzad Razi1, Juan Flores-Gonzalez1, Zaid Muslim1, Joanna F. Weber1, Cliff P. Connery2, Faiz Y. Bhora1.
1Nuvance Health, Danbury, CT, USA, 2Nuvance Health, Poughkeepsie, NY, USA.
Background: We hypothesized that postoperative day (POD)≤ 1 discharge could be safely performed following minimally-invasive lobectomy for early-stage NSCLC and sought to evaluate various patient and hospital related factors.
Methods: We identified patients with stage I NSCLC (tumor ≤ 4 cm and clinical N0, M0) who underwent minimally-invasive lobectomy in the NCDB from 2010 to 2016. Hospital surgical volume was assigned for each treating facility, based on overall minimally-invasive (robotic and videoscopic) surgical volume for lung cancer during the study period (low, median and high quartiles). A multivariable regression model was created to assess for factors associated with early discharge (POD≤ 1). Perioperative outcomes were compared between the two groups.
Results: A total of 93,550 minimally-invasive lung resections were conducted across 1125 facilities. Median number of minimally-invasive lung resections per year were 8, 30 and 98 in low quartile, median quartiles and high quartile respectively, p< 0.001. A total of 20,317 patients met our inclusion criteria with 1,689 (8.3%) discharged on POD≤ 1 and 18,628 (91.7%) discharged after POD-1. Factors associated with POD≤ 1 discharge included male sex, higher income, RML lobectomy and high-volume centers (high quartiles). Thirty- and ninety-day mortality were worse for POD≤ 1 discharge in low and median quartiles but equivalent in high volume quartiles, P< 0.001 [Figure].
Conclusion: Our analysis suggests that early discharge on POD≤ 1 following minimally-invasive lobectomy may be appropriate in high volume centers. However further work is needed to assess the various patient and hospital related factors associated with early discharge.
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