Risk factors analysis of prolonged length of hospital stay after lobectomy for lung cancer patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Huawei ¹ ,  ZHANG Linyou ²

1. Department of Thoracic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453000, Henan, P.R.China;
2. Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, P.R.China;

Corresponding author：

ZHANG Linyou, Email: lyzhang6666@gmail.com

Keywords：

Prolonged length of hospital stay; lobectomy; lung cancer

DOI：

10.7507/1007-4848.201807069

Video：

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Objective To analyze the risk factors associated with prolonged length of hospital stay (PLOS) after lobectomy for lung cancer patients. Methods The clinical records of 771 lung cancer patients undergoing lobectomy between May 2012 and June 2016 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. According to different length of hospital stay (LOS), 771 patients were divided into two groups, a normal LOS group and a PLOS group. In the normal LOS group, there were 551 patients including 234 females and 317 males with a median age of 59 years, whose LOS was shorter than 8.0 days. In the PLOS group, there were 220 patients including 72 females and 148 males with a median age of 60 years, whose LOS was no less than 8.0 days. Then, we analyzed the independent risk factors of PLOS by multivariate logistic regression analysis. Results Univariate analysis showed that risk factors for PLOS included male, arrhythmias and atrioventricular block, smaller FVC%, unilateral pneumonectomy, operation and anesthesia duration, intraoperative blood loss and number of lymph node dissection in the operation (P<0.05). Multivariate logistic regression analysis showed that the age ≥75 years (OR=4.100, 95%CI 1.677 to 10.026), unilateral pneumonectomy (OR=2.563, 95%CI 1.473 to 4.460), FVC% < 89.05% (OR=1.500, 95%CI 1.020 to 2.206), numbers of lymph node dissection≥ 13.5 (OR=1.826, 95%CI 1.262 to 2.642), operation duration≥126.5 min (OR=1.858, 95%CI 1.200 to 2.876) and arrhythmia (OR=2.944, 95%CI 1.380 to 6.284) were independent risk factors of PLOS (all P<0.05). Conclusion LOS is influenced by age, surgical type, FVC%, numbers of lymph node dissection, arrhythmia and operation duration. Careful assessment and appropriate management of risk factors are helpful to improve postoperative recovery after lobectomy for lung cancer patients.

Citation： LI Huawei, ZHANG Linyou. Risk factors analysis of prolonged length of hospital stay after lobectomy for lung cancer patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(5): 425-430. doi: 10.7507/1007-4848.201807069 Copy

1.	Krell RW, Girotti ME, Dimick JB. Extended length of stay after surgery: complications, inefficient practice, or sick patients? JAMA Surg, 2014, 149(8): 815-820.
2.	Romano PHP, Ritley D. Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives. Rockville: Agency for Healthcare Research and Quality, 2010. 1-106.
3.	Cohen ME, Bilimoria KY, Ko CY, et al. Variability in length of stay after colorectal surgery: assessment of 182 hospitals in the national surgical quality improvement Program. Ann Surg, 2009, 250(6): 901-907.
4.	Wright CD, Gaissert HA, Grab JD, et al. Predictors of prolonged length of stay after lobectomy for lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk-adjustment model. Ann Thorac Surg, 2008, 85(6): 1857-1865.
5.	Farjah F, Lou F, Rusch VW, et al. The quality metric prolonged length of stay misses clinically important adverse events. Ann Thorac Surg, 2012, 94: 881-887.
6.	Freixinet JL, Varela G, Molins L, et al. Benchmarking in thoracic surgery. Eur J Cardiothorac Surg, 2011, 40(1): 124-129.
7.	张雅娟, 闫军, 李守军, 等. 延长 Fontan 类手术患者住院时间的危险因素分析. 中国胸心血管外科临床杂志, 2014, 21(3): 312-317.
8.	Giambrone GP, Smith MC, Wu X, et al. 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-e71.
9.	Takaoka ST, Weinacker AB. The value of preoperative pulmonary rehabilitation. Thorac Surg Clin, 2005, 15(2): 203-211.
10.	Ferguson MK, Reeder LB, Mick R. Optimizing selection of patients for major lung resection. J Thorac Cardiovasc Surg, 1995, 109(2): 275-283.
11.	李华伟, 王海艳, 张临友. 肺癌患者胸腔镜下肺叶切除术中转开胸危险因素分析. 中国胸心血管外科临床杂志, 2017, 24(12): 962-969.
12.	GoPaldas RR, Bakaeen FG, Dao TK, et al. Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13619 patients. Ann Thorac Surg, 2010, 89(5): 1563-1570.
13.	Paul S, Sedrakyan A, Chiu YL, et al. Outcomes after lobectomy using thoracoscopy vs thoracotomy: a comparative effectiveness analysis utilizing the Nationwide Inpatient Sample database. Eur J Cardiothorac Surg, 2013, 43(4): 813-817.
14.	Falcoz PE, Puyraveau M, Thomas PA, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg, 2016, 49(2): 602-609.
15.	Hu Y, McMurry TL, Isbell JM, et al. Readmission after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality. J Thorac Cardiovasc Surg, 2014, 148(5): 2261-2267.

1. Krell RW, Girotti ME, Dimick JB. Extended length of stay after surgery: complications, inefficient practice, or sick patients? JAMA Surg, 2014, 149(8): 815-820.
2. Romano PHP, Ritley D. Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives. Rockville: Agency for Healthcare Research and Quality, 2010. 1-106.
3. Cohen ME, Bilimoria KY, Ko CY, et al. Variability in length of stay after colorectal surgery: assessment of 182 hospitals in the national surgical quality improvement Program. Ann Surg, 2009, 250(6): 901-907.
4. Wright CD, Gaissert HA, Grab JD, et al. Predictors of prolonged length of stay after lobectomy for lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk-adjustment model. Ann Thorac Surg, 2008, 85(6): 1857-1865.
5. Farjah F, Lou F, Rusch VW, et al. The quality metric prolonged length of stay misses clinically important adverse events. Ann Thorac Surg, 2012, 94: 881-887.
6. Freixinet JL, Varela G, Molins L, et al. Benchmarking in thoracic surgery. Eur J Cardiothorac Surg, 2011, 40(1): 124-129.
7. 张雅娟, 闫军, 李守军, 等. 延长 Fontan 类手术患者住院时间的危险因素分析. 中国胸心血管外科临床杂志, 2014, 21(3): 312-317.
8. Giambrone GP, Smith MC, Wu X, et al. 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-e71.
9. Takaoka ST, Weinacker AB. The value of preoperative pulmonary rehabilitation. Thorac Surg Clin, 2005, 15(2): 203-211.
10. Ferguson MK, Reeder LB, Mick R. Optimizing selection of patients for major lung resection. J Thorac Cardiovasc Surg, 1995, 109(2): 275-283.
11. 李华伟, 王海艳, 张临友. 肺癌患者胸腔镜下肺叶切除术中转开胸危险因素分析. 中国胸心血管外科临床杂志, 2017, 24(12): 962-969.
12. GoPaldas RR, Bakaeen FG, Dao TK, et al. Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13619 patients. Ann Thorac Surg, 2010, 89(5): 1563-1570.
13. Paul S, Sedrakyan A, Chiu YL, et al. Outcomes after lobectomy using thoracoscopy vs thoracotomy: a comparative effectiveness analysis utilizing the Nationwide Inpatient Sample database. Eur J Cardiothorac Surg, 2013, 43(4): 813-817.
14. Falcoz PE, Puyraveau M, Thomas PA, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg, 2016, 49(2): 602-609.
15. Hu Y, McMurry TL, Isbell JM, et al. Readmission after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality. J Thorac Cardiovasc Surg, 2014, 148(5): 2261-2267.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors analysis of prolonged length of hospital stay after lobectomy for lung cancer patients

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