Facility exposure to wildfire disasters and hospital length of stay following lung cancer surgery

Abstract

Background: Wildfires pose substantial health and safety threats to patients recovering from lung cancer surgery. Without specific disaster preparedness guidelines, surgical oncologists might resort to improvisational strategies, such as extending post-operative length of stay (LOS) to support surgical recovery and better protect the health and safety of patients.

Methods: Individuals aged ≥18 years who received curative-intent lobectomy or pneumonectomy for stage I-III non-small-cell lung cancer between 2004 and 2021 were selected from the National Cancer Database. Exposure was defined as a Federal Emergency Management Agency wildfire Presidential Disaster Declaration in the county of the treating facility between the date of surgery and the date of discharge from the hospital. Differences in the cumulative distribution function of LOS were evaluated between exposed and propensity score-matched unexposed patients treated at the same facility.

Results: Patients exposed to a wildfire disaster declaration in the county of the treating facility had longer LOS than unexposed patients (9.4 days compared to 7.5 days, respectively; P < .001) overall and for each stage (I-III) for which surgery is the recommended treatment modality.

Conclusions: Patients whose facility was impacted by a wildfire disaster during recovery from lung cancer surgery had longer LOS than similar patients treated at the same facility but at times when no disaster occurred. Such findings complicate the use of LOS as a post-operative quality metric. Future studies should evaluate whether extended hospital stay improves surgical care outcomes during disasters. Moreover, these findings should be considered for disaster preparedness guidelines tailored to vulnerable patient populations.