The cost and efficacy of ambulatory and hospitalized surgical resection in patients with lung tumors: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Shanshan , WANG Yue ,  MA Haiping

The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830013, P. R. China;

Corresponding author：

MA Haiping, Email: 1378016084@qq.com

Keywords：

Lung neoplasms; ambulatory surgery; efficacy; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202504080

Video：

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Objective To compare the cost and efficacy of ambulatory versus hospitalized surgery for lung tumor patients. Methods Two researchers independently conducted a computer search on February 14, 2025, in databases including CNKI (China National Knowledge Infrastructure), PubMed, Web of Science, Ovid Medline, Cochrane Library, and Wanfang Database, with the search period covering from the inception of these databases to February 2025. The outcome indicators were postoperative complication rate, length of hospital stay, and hospitalization costs. For the included randomized controlled trials and non-randomized controlled trials, we used the Cochrane risk of bias assessment tool and the Newcastle Ottawa Scale (NOS) respectively to evaluate the quality of the literature, and extracted data from the included studies for meta-analysis using RevMan 5.4 and Stata 18.0 software. Results A total of 12 articles were ultimately included, all of which were evaluated as high-quality, consisting of 2 randomized controlled trials, 2 prospective cohort studies, and 8 retrospective cohort studies, involving a total of 76 403 patients. Meta-analysis showed that the ambulatory surgery group had advantages over the hospitalized surgery group in terms of operation time [MD=−21.07, 95%CI (−30.55, −11.58), P<0.001], length of hospital stay [MD=−2.17, 95%CI (−3.25, −1.09), P<0.001], hospitalization costs [SMD=−1.22, 95%CI (−2.18, −0.26), P=0.01], and overall postoperative complications [OR=0.48, 95%CI (0.32, 0.74), P<0.001]. There was no statistically significant difference between the two groups in terms of postoperative hoarseness [OR=0.62, 95%CI (0.24, 1.61), P=0.33] and postoperative chylothorax [OR=0.27, 95%CI (0.07, 1.07), P=0.06]. Conclusion Compared to conventional hospitalized lung tumor resection, ambulatory lung tumor resection can significantly reduce the patient’s surgery and hospital stay time, decrease hospitalization costs, and reduce the incidence of postoperative complications. While improving hospital efficiency and reducing the economic burden on patients, it is worthy of further promotion and application.

1.	Leiter A, Veluswamy RR, Wisnivesky JP. The global burden of lung cancer: current status and future trends. Nat Rev Clin Oncol, 2023, 20(9): 624-639.
2.	Wu FY, Wang L, Zhou CC. Lung cancer in China: current and prospect. Curr Opin Oncol, 2020, 33(1): 40-46.
3.	刘静. DRG/DIP医保政策改革下医院服务质量与提升策略. 四川劳动保障, 2025, 2(2): 95-96.Liu J. Hospital service quality and improvement strategies under DRG/DIP medical insurance policy reform. Labor Soc Secur, 2025, 2(2): 95-96.
4.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
5.	吴柔娜, 晁敏, 毛琳. 加速康复外科在我国的研究现状及展望. 加速康复外科杂志, 2022, 5(3): 123-129.Wu RN, Chao M, Mao L. Application situation and prospect of enhanced recovery after surgery in China. J Enhanc Recov After Surg, 2022, 5(3): 123-129.
6.	钱玥, 马正良. 快速康复外科理念下日间手术的麻醉与围术期质量控制. 实用医学杂志, 2024, 40(8): 1042-1046.Qian Y, Ma ZL. Anesthesia and perioperative quality control of ambulatory surgery under the concept of rapid recovery surgery. J Pract Med, 2024, 40(8): 1042-1046.
7.	李龙, 焦作义, 罗长江. 日间手术腹腔镜胆囊切除术疗效和安全性的Meta分析. 中华普通外科学文献(电子版), 2018, 12(6): 444-450.Li L, Jiao ZY, Luo CJ. Ambulatory surgery for laparoscopic cholecystectomy: a meta-analysis. Chin Arch Gen Surg (Electron Ed), 2018, 12(6): 444-450.
8.	李雪, 胡成云, 周婉君, 等. ERAS理念下日间手术麻醉研究进展(综述). 安徽医专学报, 2024, 23(1): 32-35.Li X, Hu CY, Zhou WJ, et al. Research progress on anesthesia management in patients undergoing day surgery with ERAS (Review). J Anhui Med Coll, 2024, 23(1): 32-35.
9.	肺癌手术日间化管理中国专家共识(2024年版). 中国肺癌杂志, 2024, 27(6): 405-414.Chinese expert consensus on day surgery management of lung cancer (2024 edition). Chin J Lung Cancer, 2024, 27(6): 405-414.
10.	Shen C, Che GW. Thoracic day surgery versus thoracic inpatient surgery for treatment of patients with lung cancer: a systematic review and meta-analysis. J Cardiothorac Surg, 2023, 18(1): 341.
11.	Wang X, Wang WQ, Li JM, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014, 14(1): 135.
12.	José JY, Gerard U, Marta R, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol (Engl Ed), 2021, 74(9): 790-799.
13.	Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
14.	Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Accessed on May 29, 2024.
15.	Ding Y, Zhou L, Shan L, et al. Video-assisted thoracoscopic lung resection with or without enhanced recovery after surgery: a single institution, prospective randomized controlled study. Front Oncol, 2024, 14: 1474438.
16.	Dong YX, Zhu DJ, Che GW, et al. Clinical effect of day surgery in patients with lung cancer by optimize operating process. Chin J Lung Cancer, 2020, 23(2): 77-83.
17.	Dong YX, Shen C, Wang Y, et al. Safety and feasibility of video-assisted thoracoscopic day surgery and inpatient surgery in patients with non-small cell lung cancer: a single-center retrospective cohort study. Front Surg, 2021, 8: 779889.
18.	Drawbert HE, Hey MT, Tarrazzi F, et al. Early discharge on postoperative day 1 following lobectomy for stage I non-small-cell lung cancer is safe in high-volume surgical centres: a national cancer database analysis. Eur J Cardiothorac Surg, 2021, 61(5): 1022-1029.
19.	Geraci TC, Chang SH, Chen S, et al. Discharging patients by postoperative day one after robotic anatomic pulmonary resection. Ann Thorac Surg, 2021, 114(1): 234-240.
20.	Linden AP, Perry Y, Worrell S, et al. Postoperative day 1 discharge after anatomic lung resection: a Society of Thoracic Surgeons database analysis. J Thorac Cardiovasc Surg, 2019, 159(2): 667-678. e2.
21.	Patel DC, Leipzig M, Jeffrey Yang CF, et al. Early discharge after lobectomy for lung cancer does not equate to early readmission. Ann Thorac Surg, 2021, 113(5): 1634-1640.
22.	Towe CW, Khil A, Ho VP, et al. Early discharge after lung resection is safe: 10-year experience. J Thorac Dis, 2018, 10(10): 5870-5878.
23.	Wang C, Lai Y, Li P, et al. Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1749 cases. BMC Surg, 2021, 21(1): 115.
24.	Young AM, Viktorsson SA, Strobel RJ, et al. Five-year sustained impact of a thoracic enhanced recovery after surgery program. Ann Thorac Surg, 2024, 117(2): 422-430.
25.	Zhang G, Fan J, Yu Z, et al. Video-assisted thoracoscopic treatment as two-day surgery for lung neoplasms: a propensity-matched analysis. BMC Cancer, 2022, 22(1): 832.
26.	Zhang H, Chen W, Wang J, et al. Real-world study on the application of enhanced recovery after surgery protocol in video-assisted thoracoscopic day surgery for pulmonary nodule resection. BMC Surg, 2024, 24(1): 288.
27.	马正良, 黄宇光, 顾小萍, 等. 成人日间手术加速康复外科麻醉管理专家共识. 协和医学杂志, 2019, 10(6): 562-569.Ma ZL, Huang YG, Gu XP, et al. Expert consensus on anesthesia management of enhanced recovery after adult ambulatory surgery. Med J Peking Union Med Coll Hosp, 2019, 10(6): 562-569.
28.	四川天府新区医学会日间护理专业委员会. 日间手术病房"平急结合"管理模式专家共识. 华西医学, 2024, 39(2): 173-177.Day Surgery Nursing Committee of Sichuan Tianfu New Area Medical Association. Expert consensus on the management model of integrating emergency and routine medical care in day surgery wards. West China Med J, 2024, 39(2): 173-177.
29.	鲁发顺, 钟锴, 穆热艾合买提江·穆塔里夫, 等. 日间模式应用于腹腔镜胆囊切除术的疗效分析. 中国普外基础与临床杂志, 2021, 28(7): 856-860.Lu FS, Zhong K, Mureaihemaitijiang M, et al. Curative effect analysis of ambulatory pattern in laparoscopic cholecystectomy. Chin J Bases Clin Gen Surg, 2021, 28(7): 856-860.
30.	徐建国. 成人日间手术后镇痛专家共识(2017). 临床麻醉学杂志, 2017, 33(8): 812-815.Xu JG. Expert consensus on postoperative analgesia in adult day surgery (2017). J Clin Anesthesiol, 2017, 33(8): 812-815.
31.	Ng L, Mercer-Jones M. Day case surgery guidelines. Surgery (Oxford), 2014, 32(2): 73-78.

1. Leiter A, Veluswamy RR, Wisnivesky JP. The global burden of lung cancer: current status and future trends. Nat Rev Clin Oncol, 2023, 20(9): 624-639.
2. Wu FY, Wang L, Zhou CC. Lung cancer in China: current and prospect. Curr Opin Oncol, 2020, 33(1): 40-46.
3. 刘静. DRG/DIP医保政策改革下医院服务质量与提升策略. 四川劳动保障, 2025, 2(2): 95-96.Liu J. Hospital service quality and improvement strategies under DRG/DIP medical insurance policy reform. Labor Soc Secur, 2025, 2(2): 95-96.
4. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
5. 吴柔娜, 晁敏, 毛琳. 加速康复外科在我国的研究现状及展望. 加速康复外科杂志, 2022, 5(3): 123-129.Wu RN, Chao M, Mao L. Application situation and prospect of enhanced recovery after surgery in China. J Enhanc Recov After Surg, 2022, 5(3): 123-129.
6. 钱玥, 马正良. 快速康复外科理念下日间手术的麻醉与围术期质量控制. 实用医学杂志, 2024, 40(8): 1042-1046.Qian Y, Ma ZL. Anesthesia and perioperative quality control of ambulatory surgery under the concept of rapid recovery surgery. J Pract Med, 2024, 40(8): 1042-1046.
7. 李龙, 焦作义, 罗长江. 日间手术腹腔镜胆囊切除术疗效和安全性的Meta分析. 中华普通外科学文献(电子版), 2018, 12(6): 444-450.Li L, Jiao ZY, Luo CJ. Ambulatory surgery for laparoscopic cholecystectomy: a meta-analysis. Chin Arch Gen Surg (Electron Ed), 2018, 12(6): 444-450.
8. 李雪, 胡成云, 周婉君, 等. ERAS理念下日间手术麻醉研究进展(综述). 安徽医专学报, 2024, 23(1): 32-35.Li X, Hu CY, Zhou WJ, et al. Research progress on anesthesia management in patients undergoing day surgery with ERAS (Review). J Anhui Med Coll, 2024, 23(1): 32-35.
9. 肺癌手术日间化管理中国专家共识(2024年版). 中国肺癌杂志, 2024, 27(6): 405-414.Chinese expert consensus on day surgery management of lung cancer (2024 edition). Chin J Lung Cancer, 2024, 27(6): 405-414.
10. Shen C, Che GW. Thoracic day surgery versus thoracic inpatient surgery for treatment of patients with lung cancer: a systematic review and meta-analysis. J Cardiothorac Surg, 2023, 18(1): 341.
11. Wang X, Wang WQ, Li JM, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014, 14(1): 135.
12. José JY, Gerard U, Marta R, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol (Engl Ed), 2021, 74(9): 790-799.
13. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
14. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Accessed on May 29, 2024.
15. Ding Y, Zhou L, Shan L, et al. Video-assisted thoracoscopic lung resection with or without enhanced recovery after surgery: a single institution, prospective randomized controlled study. Front Oncol, 2024, 14: 1474438.
16. Dong YX, Zhu DJ, Che GW, et al. Clinical effect of day surgery in patients with lung cancer by optimize operating process. Chin J Lung Cancer, 2020, 23(2): 77-83.
17. Dong YX, Shen C, Wang Y, et al. Safety and feasibility of video-assisted thoracoscopic day surgery and inpatient surgery in patients with non-small cell lung cancer: a single-center retrospective cohort study. Front Surg, 2021, 8: 779889.
18. Drawbert HE, Hey MT, Tarrazzi F, et al. Early discharge on postoperative day 1 following lobectomy for stage I non-small-cell lung cancer is safe in high-volume surgical centres: a national cancer database analysis. Eur J Cardiothorac Surg, 2021, 61(5): 1022-1029.
19. Geraci TC, Chang SH, Chen S, et al. Discharging patients by postoperative day one after robotic anatomic pulmonary resection. Ann Thorac Surg, 2021, 114(1): 234-240.
20. Linden AP, Perry Y, Worrell S, et al. Postoperative day 1 discharge after anatomic lung resection: a Society of Thoracic Surgeons database analysis. J Thorac Cardiovasc Surg, 2019, 159(2): 667-678. e2.
21. Patel DC, Leipzig M, Jeffrey Yang CF, et al. Early discharge after lobectomy for lung cancer does not equate to early readmission. Ann Thorac Surg, 2021, 113(5): 1634-1640.
22. Towe CW, Khil A, Ho VP, et al. Early discharge after lung resection is safe: 10-year experience. J Thorac Dis, 2018, 10(10): 5870-5878.
23. Wang C, Lai Y, Li P, et al. Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1749 cases. BMC Surg, 2021, 21(1): 115.
24. Young AM, Viktorsson SA, Strobel RJ, et al. Five-year sustained impact of a thoracic enhanced recovery after surgery program. Ann Thorac Surg, 2024, 117(2): 422-430.
25. Zhang G, Fan J, Yu Z, et al. Video-assisted thoracoscopic treatment as two-day surgery for lung neoplasms: a propensity-matched analysis. BMC Cancer, 2022, 22(1): 832.
26. Zhang H, Chen W, Wang J, et al. Real-world study on the application of enhanced recovery after surgery protocol in video-assisted thoracoscopic day surgery for pulmonary nodule resection. BMC Surg, 2024, 24(1): 288.
27. 马正良, 黄宇光, 顾小萍, 等. 成人日间手术加速康复外科麻醉管理专家共识. 协和医学杂志, 2019, 10(6): 562-569.Ma ZL, Huang YG, Gu XP, et al. Expert consensus on anesthesia management of enhanced recovery after adult ambulatory surgery. Med J Peking Union Med Coll Hosp, 2019, 10(6): 562-569.
28. 四川天府新区医学会日间护理专业委员会. 日间手术病房"平急结合"管理模式专家共识. 华西医学, 2024, 39(2): 173-177.Day Surgery Nursing Committee of Sichuan Tianfu New Area Medical Association. Expert consensus on the management model of integrating emergency and routine medical care in day surgery wards. West China Med J, 2024, 39(2): 173-177.
29. 鲁发顺, 钟锴, 穆热艾合买提江·穆塔里夫, 等. 日间模式应用于腹腔镜胆囊切除术的疗效分析. 中国普外基础与临床杂志, 2021, 28(7): 856-860.Lu FS, Zhong K, Mureaihemaitijiang M, et al. Curative effect analysis of ambulatory pattern in laparoscopic cholecystectomy. Chin J Bases Clin Gen Surg, 2021, 28(7): 856-860.
30. 徐建国. 成人日间手术后镇痛专家共识(2017). 临床麻醉学杂志, 2017, 33(8): 812-815.Xu JG. Expert consensus on postoperative analgesia in adult day surgery (2017). J Clin Anesthesiol, 2017, 33(8): 812-815.
31. Ng L, Mercer-Jones M. Day case surgery guidelines. Surgery (Oxford), 2014, 32(2): 73-78.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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