Intensive care unit admissions following enhanced recovery video-assisted thoracoscopic surgery lobectomy

Abstract

Objectives: Video-assisted thoracoscopic surgery (VATS) lobectomy combined with enhanced recovery after surgery (ERAS) protocols has improved postoperative outcomes, yet concerns persist regarding complications and readmissions. Limited research has explored intensive care unit (ICU) admissions and outcomes within this context. The goal of this study was to analyse ICU admissions following VATS lobectomy within an established ERAS protocol.

Methods: Consecutive patients who underwent VATS lobectomy between 2018 and 2023 were included. Patient data were obtained from our prospective institutional database, while ICU data were extracted from electronic patient records.

Results: Of 2099 patients included, 48 (2.3%) required ICU admission. The median age was 70 (interquartile range: 64-76) years, with ICU patients being older and predominantly male (73%). Overall 30-day mortality was 1.0% with an ICU mortality of 31%. Multiple logistic regression revealed significant associations between ICU admission and male gender (P ≤ 0.001), diabetes mellitus (P = 0.026), heart failure (P = 0.040) and diffusing capacity for carbon monoxide (0.013). Median time to ICU admission was 4 days (interquartile range: 2-10). Respiratory failure was the primary reason for ICU admission (60%). Severe surgical complications accounted for 8.3% of all ICU admissions.

Conclusions: In an ERAS setting, the incidence of ICU admissions following VATS lobectomy was 2.3%, with a mortality rate of 31%. Respiratory failure was the leading cause of ICU admission.

Keywords: Enhanced recovery; Intensive care unit; Lobectomy; Video-assisted thoracoscopic surgery.