Safety and efficiency of video-assisted thoracoscopic wedge resection as day surgery for lung neoplasms using enhanced recovery after surgery: a single-center retrospective cohort study

Abstract

Abstract Background Enhanced recovery after surgery (ERAS) protocols and minimally invasive technology have improved clinical outcomes and reduced hospital stay length. This study aimed to evaluate the safety and efficiency of video-assisted thoracoscopic surgery (VATS) wedge resection as day surgery for lung neoplasms. Methods This single-center, retrospective cohort analysis was performed from August 2022 to November 2022. A total of 1043 patients scheduled to undergo VATS wedge resection were included, comprising 294 patients for day surgery and 749 patients for inpatient surgery. After propensity score matching (1:1), 568 patients were included in the final analysis, with 284 in the day surgery group and 284 in the inpatient surgery group. Matching was performed on the basis of sex, age, medical insurance, smoking history, diabetes history, hypertension history, surgical side and type of neoplasm. Results In the day surgery group, the 24 h discharge rate was 43.31% (123/284), and the 48 h discharge rate was 97.54% (277/284). There was no significant difference between the two groups in the incidence of postoperative complications (2.46% vs. 4.23%, p = 0.243), with prolonged air leaks being the most common complication. However, the total incidence of anesthesia-related adverse events was lower in the day surgery group than in the inpatient surgery group (23.59% vs. 36.27%, p = 0.001), and postoperative pain scores were also significantly lower in the day surgery group. In terms of medical efficiency and economy, the day surgery group showed a shorter length of total hospital stay (1.73 ± 0.81 vs. 4.80 ± 1.52 days, p < 0.001) and postoperative stay (1.54 ± 1.10 vs. 2.55 ± 0.92 days, p < 0.001), as well as lower total hospitalization costs (47440.30 ± 10870.63 vs. 57276.89 ± 12126.13 RBM, p < 0.001) and significant reductions in drug costs, materials costs for treatment and anesthesia costs. Conclusions The study results demonstrated that VATS day surgery can reduce hospital stay and pain, decrease hospitalization expenses, and optimize the use of medical resources while maintaining the same quality of medical care for selected patients. These results indicate the safety and efficiency of VATS wedge resection as day surgery for lung neoplasms when implemented using ERAS protocols.