| OBJECTIVEThis retrospective study aims to analyze the risk factors associated with prolonged length of hospital stay(LOS)after receiving video-assisted thoracic surgery patients.In order to improve the perioperative management and provide a theoretical basis for the intraoperative anaesthesia management through Enhanced Recovery After Surgery.METHODA total of 295 patients were selected who underwent 3-port video-assisted thoracic surgery with single lung lobe in our central and eastern hospitals from January 2019 to December 2019.After selected by inclusion and exclusion criteria,the remaining 181 patients were included in the study.Collecting the perioperative data of the patient,such as the length of hospital stay after surgery,the totol dosage of opioid drugs and nonsteroidal anti-inflammatory drugs during operation and 48 hours after operation,the amount of fluid during operation,the difference of hemoglobin before received surgery and after received surgery,the total time of whole operation,the albumin before received surgery and after received surgery,water-electrolytes before received surgery and after received surgery.RESULTSAfter select by inclusion and exclusion criteria,the final number of cases included in the study were 181.Preoperative albumin was a single factor related to the length of stay after surgery(normal length of stay after surgery group 42.68±4.23 g/L,prolong length of stay after surgery group 40.69±3.8g/L,normal length of stay after surgery group was higher than prolong length of stay after surgery group,P=0.001).The difference of hemoglobin before received surgery and after received surgery(normal length of stay after surgery group 15.23±7.44 g/L,prolong length of stay after surgery group 18.40±7.58 g/L,normal length of stay after surgery group was less than prolong length of stay after surgery group,P=0.006).Complications occurred during the perioperative period(normal length of stay after surgery group 5.1%,prolong length of stay after surgery group 30.1%,normal length of stay after surgery group was lower than prolong length of stay after surgery group,P=0.000).The quantity of drainage fluid after operation(normal length of stay after surgery group 507.50±218.21ml,prolong length of stay after surgery group was 1959.52±2204.45ml,normal length of stay after surgery group was less than prolong length of stay after surgery group,P=0.000).Total operation time(normal length of stay after surgery group 140.58±60.36min,prolong length of stay after surgery group 161.07±47.65min,normal length of stay after surgery group was less than prolong length of stay after surgery group,P=0.012).ASA grade(normal length of stay after surgery group ASA? grade accounted for 6.4%,prolong length of stay after surgery group ASA? grade accounted for 16.5%,prolong length of stay after surgery group has more patient who was assessed ASA? grade than normal discharge group,P=0.037),postoperative albumin(normal length of stay after surgery group 34.88±2.54 g/L,prolong length of stay after surgery group 33.53±3.11g/L,prolong length of stay after surgery group was lower than normal length of stay after surgery group,P=0.001).Pathological type(normal length of stay after surgery group squamous cell carcinoma 3.8%,prolong length of stay after surgery group squamous cell carcinoma 15.5%,prolong length of stay after surgery group squamous cell carcinoma case was more than normal length of stay after surgery group,P=0.035).Postoperative non-steroidal anti-inflammatory drugs and opioid drugs like flurbiprofen axetil(normal length of stay after surgery group 111.54±62.38mg,prolong length of stay after surgery group 140.29±96.27mg,normal length of stay after surgery group was less than prolong length of stay after surgery group,P=0.030).Dizoxin(normal length of stay after surgery group 9.94±16.52mg,prolong length of stay after surgery group 3.83±12.95mg,normal length of stay after surgery group was used more dizoxin than prolong length of stay after surgery group,P=0.000).Pentazocine(normal length of stay after surgery group 3.85±14.79mg,prolong length of stay after surgery group 12.23±24.29mg,prolong length of stay after surgery usage was more than normal length of stay after surgery group,P=0.008).Ketorolac tromethamine usage(normal length of stay after surgery group 113.85 ± 92.29mg,prolong length of stay after surgery 140.97±86.89mg,normal length of stay after surgery group usage was less than prolong length of stay after surgery,P=0.044).Smoking index(normal length of stay after surgery group 135.03±344.71,prolong length of stay after surgery group 302.82±499.13,normal length of stay after surgery group smoking index was less than prolong length of stay after surgery group,P=0.012).The drainage tube was removed after surgery days(normal length of stay after surgery group 2.45±0.66days,prolong length of stay after surgery group 6.40±4.66days,P=0.000).Postoperative phosphorus was normal and low(normal length of stay after surgery group postoperative phosphorus was 26.9%,prolong length of stay after surgery group 9.7%,normal length of stay after surgery group postoperative phosphorus was lower than prolong length of stay after surgery group,P=0.003),only resection lung segment(42.3%of patients who receive lung segment surgery in normal length of stay after surgery group,26.2%in prolong length of stay after surgery group,the patients who receive lung segment surgery in normal length of stay after surgery group was more than prolong length of stay after surgery group,P=0.023).In multivariate logistics regression analysis,preoperative albumin,the difference of hemoglobin before received surgery and after received surgery,complications occurred during the perioperative period and postoperative drainage volume were independent risk factors that affected postoperative discharge time.Among them,preoperative albumin which after grouping the odds ratio was 2.929,the difference of hemoglobin before received surgery and after received surgery the odds ratio was 0.300,complications occurred during the perioperative period the odds ratio was 0.248,postoperative drainage volume the odds ratio was 1.005.CONCLUSIONAfter the patient underwent radical thoracoscopic surgery for lung cancer,preoperative albumin,the difference of hemoglobin before received surgery and after received surgery,postoperative drainage,and the use of non-steroidal anti-inflammatory drugs were all factors that affected postoperative rehabilitation and discharge. |
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