Postoperative day 1 discharge for segmentectomy using a minimally invasive approach after drain removal on the day of surgery.

Abstract

Background: Although early removal of postoperative chest drains in segmentectomy may be difficult due to the management of air leakage in intersegmental planes, patients can be discharged earlier if it is successfully achieved. In segmentectomy, we evaluated the feasibility of postoperative day (POD) 1 discharge using a minimally invasive approach (MIA) after drain removal on the day of surgery (DOS).

Methods: Ninety patients who underwent segmentectomy via MIA between July 2021 and September 2023 were included in this retrospective study. These patients were divided into those who received drain removal on DOS or after DOS. Clinical characteristics and perioperative outcomes were compared between the two groups. In addition, the factors associated with drain removal on DOS and discharge on POD1 in the patients who received drain removal on DOS were identified.

Results: Drains were removed on DOS in 67 patients (74.4%). Therefore, the 90 patients were divided into those who underwent drain removal on DOS (n=67) or after DOS (n=23). Patients who underwent drain removal on DOS had significantly higher forced expiratory volume in 1 second (FEV1.0) % (P=0.03) and shorter postoperative hospital stay (P<0.001). In multivariate analyses, FEV1.0% was significantly associated with drain removal on DOS (odds ratio: 0.934, 95% confidence interval: 0.880-0.993, P=0.03). Of the 67 patients who underwent drain removal on DOS, 31 (46.3%) were discharged on POD1. Among the variables, surgery performed by the chief surgeon was significantly associated with discharge on POD1 (vs. others, odds ratio: 0.117, 95% confidence interval: 0.019-0.730, P=0.02).

Conclusions: POD1 discharge for segmentectomy using a MIA after drain removal on DOS is considered feasible. However, we still have room for improvement as 53.7% of patients were discharged on POD2 or later despite drain removal on DOS.