# Temporal Trends in Outcomes and Predictors of Length of Stay Following Lung Cancer Resection Over 10 Years With Enhanced Recovery After Surgery

## TL;DR

This study shows that using a 14-step Enhanced Recovery After Surgery program for lung cancer patients over 10 years reduced hospital stays and improved recovery outcomes.

## Contribution

The study provides updated insights into long-term ERAS program effectiveness and identifies specific predictors of prolonged hospital stays.

## Key findings

- Median hospital stay decreased from 5 to 4 days over the 10-year period.
- In-hospital mortality and major morbidity rates significantly declined.
- Older age, open surgery, and intensive care were linked to longer hospital stays.

## Abstract

Enhanced Recovery After Surgery aims to accelerate recovery, with length of stay as a key metric. This study assessed temporal trends in short-term outcomes within a maturing programme and identified factors associated with increased hospital stay.

Data were prospectively collected for consecutive patients undergoing lung cancer resection following a 14-step protocol between 2013 and 2023. Primary outcome was length of stay. Secondary outcomes included 30-day mortality, morbidity, re-admission, and reoperation rates. Predictors of length of stay were analysed using linear regression.

We included 2192 patients; procedures included lobectomy (61%), wedge resection (23%), segmentectomy (10%), pneumonectomy (3.5%), and bi-lobectomy (2.7%). Video-assisted thoracoscopic surgery was used in 80% of cases. Median length of stay decreased from 5 to 4 days (P < .001), while protocol adherence increased from 10/14 to 12/14 (P = .01). In-hospital mortality (2.9% to 1.0%, P < .001) and major morbidity (12.2% to 5.6%, P < .001) both declined. In multivariable linear regression, factors associated with longer stay included age (β = 0.17, CI 0.13 to 0.20, P < .001), higher American Society of Anesthesiologists score (β = 1.12, CI 1.04 to 2.2, P = .02), open surgery (β = 1.0, CI 0.17 to 2.2, P = .043), thoracoscopic-to-open converted surgery (β = 1.49, CI 0.96 to 1.9, P = .03), and intensive care (β = 3.4, CI 2.5 to 4.3, P < .001). Protective factors were early mobilization (β = −0.90, CI −1.9 to 0.33, P = .005) and opioid avoidance (β = −0.72, CI −2.4 to 0.99, P = .038).

Sustained use of an Enhanced Recovery After Surgery programme was associated with shorter hospitalization and reduced morbidity. Factors associated with length of stay can identify patients at risk of delayed recovery and prioritize elements for optimization within recovery pathways.

Enhanced Recovery After Surgery (ERAS) protocols are evidence-based, multimodal peri-operative pathways designed to accelerate recovery, reduce hospital stay, and improve outcomes.