Predictors of prolonged hospital stay after segmentectomy

Fatemehsadat Pezeshkian; Rachel Leo; Miles A McAllister; Anupama Singh; Emanuele Mazzola; Fatemeh Hooshmand; Julio Herrera-Zamora; Mia Silvestri; Rafael Ribeiro Barcelos; Raphael Bueno; Paula Ugalde Figueroa; Michael T Jaklitsch; Scott J Swanson

doi:10.1016/j.jtcvs.2024.04.021

Predictors of prolonged hospital stay after segmentectomy

J Thorac Cardiovasc Surg. 2024 Apr 28:S0022-5223(24)00365-9. doi: 10.1016/j.jtcvs.2024.04.021. Online ahead of print.

Affiliations

¹ Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address: fpezeshkian@bwh.harvard.edu.
² Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
³ Department of Data Science, Dana-Farber Cancer Institute, Boston, Mass.

PMID: 38688448
DOI: 10.1016/j.jtcvs.2024.04.021

Abstract

Objective: Segmentectomy is becoming the standard of care for small, peripheral non-small cell lung cancer. To improve perioperative management in this population, this study aims to identify factors influencing hospital length of stay after segmentectomy.

Methods: Patients who underwent segmentectomy for any indication between January 2018 and May 2023 were identified using a prospectively maintained institutional database. Multivariable logistic regression models were used to estimate associations between clinical features and prolonged (≥3 days) hospital stay. A nomogram was designed to understand better and possibly calculate the individual risk of prolonged hospital stays.

Results: In total, 533 cases were included; 337 (63%) were female. Median age was 66 years (interquartile range [IQR], 63-75). The median size of resected lesions was 1.6 cm (IQR, 1.3-2.1 cm). Median hospital stay was 3 days (IQR, 2-4 days). Major adverse events occurred in 31 (5.8%) cases. The 30-day readmission rate was 5.8% (n = 31). There was no 30-day mortality; 90-day mortality was <1%. Patients older than 75 years (odds ratio [OR], 2.01, 95% confidence interval [CI], 1.15-3.57, P = .02), those with forced expiratory volume in 1 second <88% predicted (OR, 1.99; 95% CI, 1.38-2.89, P < .001), or positive smoking history (OR, 1.72; 95% CI, 1.15-2.60, P = .01) were more likely to have prolonged hospital stays after segmentectomy. A nomogram accounting for age, sex, forced expiratory volume in 1 second, body mass index, smoking history, and comorbidities was created to predict the probability of prolonged hospital stay with an area under the receiver operating characteristic curve of 0.66.

Conclusions: Older patients, those with reduced pulmonary function, and current and past smokers have elevated risk for prolonged hospital stays after segmentectomy. Validation of our nomogram could improve perioperative risk stratification in patients who undergo segmentectomy.

Keywords: minimally invasive lung resection; nomogram; perioperative management; prolonged length of stay; segmentectomy.