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. 2023 Apr 28;15(4):1785-1793.
doi: 10.21037/jtd-23-407. Epub 2023 Apr 26.

Association between length of stay and postoperative survival in patients with lung cancer: a propensity score matching analysis based on National Cancer Database

Weicheng Kong #  1 , Haoran Wang #  2   3 , Yanyan Chen  4   5 , Juntao Xie  6 , Binhao Huang  5   7 , Liang Fang  8 , Wenjuan Chen  9 , Wei Shao  10 , Jie Zhang  3   5
Affiliations

Association between length of stay and postoperative survival in patients with lung cancer: a propensity score matching analysis based on National Cancer Database

Weicheng Kong et al. J Thorac Dis. .

Abstract

Background: Postoperative complications tend to result in prolonged hospitalization. The aim of this study was to investigate whether prolonged postoperative length of stay (LOS) can predict patient survival, particularly long-term survival.

Methods: All patients undergoing lung cancer surgery between 2004 and 2015 were identified in the National Cancer Database (NCDB). The highest quintile of LOS (more than 8 days) was defined as prolonged length of stay (PLOS). We performed 1:1 propensity score matching (PSM) between the groups with and without PLOS (Non-PLOS). Excluding confounding factors, postoperative LOS was used as a surrogate for postoperative complications. Kaplan-Meier and Cox proportional hazards survival analyses were performed to analyze survival.

Results: A total of 88,007 patients were identified. After matching, 18,585 patients were enrolled in the PLOS and Non-PLOS groups, respectively. Before and after matching, 30-day rehospitalization rate and 90-day mortality in the PLOS group were significantly higher than they were in the Non-PLOS group (P<0.001), indicating a potential worse short-term postoperative survival. After matching, the median survival of the PLOS group was significantly lower than that of the Non-PLOS group (53.2 vs. 63.5 months, P<0.0001). Multivariable analysis revealed that PLOS is independent negative predictor of overall survival [OS; hazard ratio (HR) =1.263, 95% confidence interval (CI): 1.227 to 1.301, P<0.001]. In addition, age (<70 or ≥70), gender, race, income, year of diagnosis, surgery type, pathological stage, and neoadjuvant therapy also were independent prognostic factors of postoperative survival for patients with lung cancer (all P<0.001).

Conclusions: Postoperative LOS could be taken as the quantitative indicator of postoperative complications of lung cancer in NCDB. In this study, PLOS predicted worse short-term and long-term survival independent of other factors. Avoiding PLOS could be considered to benefit patient survival after lung cancer surgery.

Keywords: Lung cancer; postoperative complications; postoperative survival; prolonged length of stay (PLOS).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-407/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient selection flowchart. Included patients were screened sequentially following the exclusion criteria.
Figure 2
Figure 2
Kaplan-Meier analysis for patients before and after matching. Survival curves were compared between PLOS and Non-PLOS groups. Dashed lines indicate median survival. PSM, propensity score matching; PLOS, prolonged length of stay.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin 2022;72:7-33. 10.3322/caac.21708 - DOI - PubMed
    1. Ettinger DS, Wood DE, Aisner DL, et al. NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 2.2021. J Natl Compr Canc Netw 2021;19:254-66. 10.6004/jnccn.2021.0013 - DOI - PubMed
    1. Petersen RH, Huang L, Kehlet H. Guidelines for enhanced recovery after lung surgery: need for re-analysis. Eur J Cardiothorac Surg 2021;59:291-2. 10.1093/ejcts/ezaa435 - DOI - PubMed
    1. Li R, Wang K, Qu C, et al. The effect of the enhanced recovery after surgery program on lung cancer surgery: a systematic review and meta-analysis. J Thorac Dis 2021;13:3566-86. 10.21037/jtd-21-433 - DOI - PMC - PubMed
    1. McDevitt J, Kelly M, Comber H, et al. A population-based study of hospital length of stay and emergency readmission following surgery for non-small-cell lung cancer. Eur J Cardiothorac Surg 2013;44:e253-9. 10.1093/ejcts/ezt389 - DOI - PMC - PubMed

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