Perioperative outcomes in lung cancer: transfer vs. outpatient admission routes

Abstract

Objectives: This study aimed to compare perioperative features of lung cancer patients admitted via different routes and their short-term prognosis impact.

Methods: A retrospective analysis included 116 consecutive patients transferred from other departments for video-assisted thoracoscopic surgery (VATS) from June 2021 - June 2024 and 353 outpatients who underwent VATS during the same period. A total of 218 patients were obtained through propensity score matching (1:1), including 109 patients in the transferred lung cancer group and 109 patients in the outpatient lung cancer group. Perioperative characteristics and short-term prognosis were compared with multivariate binary logistic regression for risk factors.

Results: A significant proportion of lung cancer patients transferred from the Department of Respiratory Medicine to the Department of Thoracic Surgery for surgical resection exhibited more complex clinical profiles than their outpatient counterparts. These patients were generally older, with poorer lung function, more advanced tumor stages, higher ASA, hypoplastic interlobar fissures, and severe pleural adhesions.​During the perioperative period, transferred patients had a higher incidence of postoperative pulmonary infections, longer hospital stays, greater hospitalization costs, and a higher 30-day readmission rate. Multivariate regression analysis identified two independent risk factors for postoperative pulmonary infection in the transferred group: longer operation time (OR = 1.011, 95% CI = 1.001-1.021, P = 0.038) and lower FEV1 levels (OR = 0.377, 95% CI = 0.156-0.911, P = 0.03).

Conclusions: Significant differences exist in perioperative characteristics and short-term prognosis between transferred and outpatient lung cancer patients. When admitting transferred patients, develop individualized treatment plans, enhance multidisciplinary collaboration, and streamline transfer processes to improve efficiency. Address psychological needs through timely interventions while optimizing preoperative pulmonary function. Without compromising surgical safety or oncological outcomes, minimize operative duration to enhance overall treatment efficacy and postoperative recovery quality.

Keywords: Complications; Lung cancer; Multidisciplinary; Operation time; Perioperative period; Transfer to another department; VATS.