Predictors of Prolonged Hospital Stay After Segmentectomy.

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 01/2018-05/2023 were identified using a prospectively maintained institutional database. Multivariable logistic regression models were used to estimate associations between clinical features and prolonged (≥ 3days) 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 females. Median age was 66 years (IQR: 63-75). The median size of resected lesions was 1.6cm (IQR 1.3-2.1). Median hospital stay was 3 days (IQR: 2-4). 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 (OR=2.01, 95%CI: 1.15-3.57, P=0.02), those with FEV1 < 88% predicted (OR = 1.99, 95%CI: 1.38-2.89, P<0.001), or positive smoking history (OR=1.72, 95%CI: 1.15-2.60, P=0.01) were more likely to have prolonged hospital stays after segmentectomy. A nomogram accounting for age, sex, FEV1, body mass index, smoking history, and comorbidities was created to predict the probability of prolonged hospital stay with an AUC of 0.66.

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