Postoperative Day 1 Discharge for Segmentectomy Using a Minimally Invasive Approach After Drain Removal on the Day of Surgery

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2025 Feb 20

PMID 39975712

Authors

Hitoshi Igai

Akinobu Ida

Kazuki Numajiri

Kazuhito Nii

Mitsuhiro Kamiyoshihara

Affiliations

Soon will be listed here.

Abstract

Background: Although early removal of postoperative chest drains in segmentectomy may be difficult due to the management of air leakage in intersegmental planes, patients can be discharged earlier if it is successfully achieved. In segmentectomy, we evaluated the feasibility of postoperative day (POD) 1 discharge using a minimally invasive approach (MIA) after drain removal on the day of surgery (DOS).

Methods: Ninety patients who underwent segmentectomy via MIA between July 2021 and September 2023 were included in this retrospective study. These patients were divided into those who received drain removal on DOS or after DOS. Clinical characteristics and perioperative outcomes were compared between the two groups. In addition, the factors associated with drain removal on DOS and discharge on POD1 in the patients who received drain removal on DOS were identified.

Results: Drains were removed on DOS in 67 patients (74.4%). Therefore, the 90 patients were divided into those who underwent drain removal on DOS (n=67) or after DOS (n=23). Patients who underwent drain removal on DOS had significantly higher forced expiratory volume in 1 second (FEV1.0) % (P=0.03) and shorter postoperative hospital stay (P<0.001). In multivariate analyses, FEV1.0% was significantly associated with drain removal on DOS (odds ratio: 0.934, 95% confidence interval: 0.880-0.993, P=0.03). Of the 67 patients who underwent drain removal on DOS, 31 (46.3%) were discharged on POD1. Among the variables, surgery performed by the chief surgeon was significantly associated with discharge on POD1 (. others, odds ratio: 0.117, 95% confidence interval: 0.019-0.730, P=0.02).

Conclusions: POD1 discharge for segmentectomy using a MIA after drain removal on DOS is considered feasible. However, we still have room for improvement as 53.7% of patients were discharged on POD2 or later despite drain removal on DOS.

References

Haro G, Sheu B, Marcus S, Sarin A, Campbell L, Jablons D . Perioperative Lung Resection Outcomes After Implementation of a Multidisciplinary, Evidence-based Thoracic ERAS Program. Ann Surg. 2019; 274(6):e1008-e1013. DOI: 10.1097/SLA.0000000000003719. View

Giambrone G, Smith M, Wu X, Gaber-Baylis L, Bhat A, Zabih R . Variability in length of stay after uncomplicated pulmonary lobectomy: is length of stay a quality metric or a patient metric?†. Eur J Cardiothorac Surg. 2016; 49(4):e65-71. PMC: 5006293. DOI: 10.1093/ejcts/ezv476. View

Igai H, Kamiyoshihara M . A uniportal thoracoscopic fissureless lingual segmentectomy for a patient with a dense fissure. Multimed Man Cardiothorac Surg. 2023; 2023. DOI: 10.1510/mmcts.2023.021. View

Matsuura N, Igai H, Ohsawa F, Numajiri K, Kamiyoshihara M . Novel thoracoscopic segmentectomy combining preoperative three-dimensional image simulation and intravenous administration of indocyanine green. Interact Cardiovasc Thorac Surg. 2022; 35(2). PMC: 9297503. DOI: 10.1093/icvts/ivac064. View

Greer S, Miller A, Smith J, Holcombe J, Headrick Jr J . Safety of Next Day Discharge After Lobectomy: Have We Broken the Speed Limit?. Ann Thorac Surg. 2018; 106(4):998-1001. DOI: 10.1016/j.athoracsur.2018.05.034. View

Handy Jr J, Child A, Grunkemeier G, Fowler P, Asaph J, Douville E . Hospital readmission after pulmonary resection: prevalence, patterns, and predisposing characteristics. Ann Thorac Surg. 2002; 72(6):1855-9; discussion 1859-60. DOI: 10.1016/s0003-4975(01)03247-7. View

Murakami J, Ueda K, Tanaka T, Kobayashi T, Kunihiro Y, Hamano K . The Validation of a No-Drain Policy After Thoracoscopic Major Lung Resection. Ann Thorac Surg. 2017; 104(3):1005-1011. DOI: 10.1016/j.athoracsur.2017.03.030. View

Batchelor T, Rasburn N, Abdelnour-Berchtold E, Brunelli A, Cerfolio R, Gonzalez M . Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2018; 55(1):91-115. DOI: 10.1093/ejcts/ezy301. View

Rogers L, Bleetman D, Messenger D, Joshi N, Wood L, Rasburn N . The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer. J Thorac Cardiovasc Surg. 2018; 155(4):1843-1852. DOI: 10.1016/j.jtcvs.2017.10.151. View

10.

Chen X, Jin R, Xiang J, Han D, Zhang Y, Li C . Methods for Dissecting Intersegmental Planes in Segmentectomy: A Randomized Controlled Trial. Ann Thorac Surg. 2020; 110(1):258-264. DOI: 10.1016/j.athoracsur.2020.02.013. View

11.

Madani A, Fiore Jr J, Wang Y, Bejjani J, Sivakumaran L, Mata J . An enhanced recovery pathway reduces duration of stay and complications after open pulmonary lobectomy. Surgery. 2015; 158(4):899-908. DOI: 10.1016/j.surg.2015.04.046. View

12.

Hanna T, King W, Thibodeau S, Jalink M, Paulin G, Harvey-Jones E . Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020; 371:m4087. PMC: 7610021. DOI: 10.1136/bmj.m4087. View

13.

Dolan D, Visa M, Lee D, Lung K, Avella Patino D, Kurihara C . Rapid Discharge After Anatomic Lung Resection: Is Ambulatory Surgery for Early Lung Cancer Possible?. Ann Thorac Surg. 2023; 117(2):297-303. DOI: 10.1016/j.athoracsur.2023.07.046. View

14.

Pfeuty K, Lenot B . Early postoperative day 0 chest tube removal using a digital drainage device protocol after thoracoscopic major pulmonary resection. Interact Cardiovasc Thorac Surg. 2020; 31(5):657-663. DOI: 10.1093/icvts/ivaa170. View

15.

Igai H, Kamiyoshihara M, Yoshikawa R, Osawa F, Kawatani N, Ibe T . The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures. J Thorac Dis. 2017; 8(12):3691-3696. PMC: 5227190. DOI: 10.21037/jtd.2016.12.58. View

16.

Geraci T, Chang S, Chen S, Ferrari-Light D, Cerfolio R . Discharging Patients by Postoperative Day One After Robotic Anatomic Pulmonary Resection. Ann Thorac Surg. 2021; 114(1):234-240. DOI: 10.1016/j.athoracsur.2021.06.088. View

17.

Freeman R, Dilts J, Ascioti A, Dake M, Mahidhara R . A comparison of length of stay, readmission rate, and facility reimbursement after lobectomy of the lung. Ann Thorac Surg. 2013; 96(5):1740-5. DOI: 10.1016/j.athoracsur.2013.06.053. View

18.

Suzuki K, Saji H, Aokage K, Watanabe S, Okada M, Mizusawa J . Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg. 2019; 158(3):895-907. DOI: 10.1016/j.jtcvs.2019.03.090. View

19.

Igai H, Matsuura N, Numajiri K, Ohsawa F, Kamiyoshihara M . Early chest drain removal on the day of uniportal thoracoscopic segmentectomy. Gen Thorac Cardiovasc Surg. 2023; 71(12):700-707. DOI: 10.1007/s11748-023-01951-6. View

20.

Fiore Jr J, Bejjani J, Conrad K, Niculiseanu P, Landry T, Lee L . Systematic review of the influence of enhanced recovery pathways in elective lung resection. J Thorac Cardiovasc Surg. 2015; 151(3):708-715.e6. DOI: 10.1016/j.jtcvs.2015.09.112. View