Risk factors for unplanned revisits in patients received thoracoscopic assisted pulmonary nodule surgery

ObjectiveTo explore the risk factors of unplanned hospital visiting in patients received video-assisted thoracic surgery （VAST） for pulmonary nodule resections based on enhanced recovery after surgery （ERAS）. MethodsA retrospective study was performed to analyze the clinical date of 767 patients received VAST for pulmonary resections based on ERAS in Day Care Unit of Nanjing Drum Tower Hospital from January 2021 to December 2022. Patients were divided into unplanned revisiting group and conventional visiting group according to whether they had unplanned hospital visiting. The risk factors of unplanned hospital visiting were analyzed and prediction model was developed. The receiver operating characteristic （ROC） was used to analyze the predictive factors. ResultsThere were 51 patients （6.65%） with unplanned hospital visiting after discharge. Compared with the conventional visiting group, the ASA grade was significantly higher, the proportion of smoking and air leak≥2 grade were increased, the thoracic drainage time and the level of C-reactive protein(CRP) at first day after operation were increased in unplanned revisiting group （P＜0.05）. The logistic regression analysis showed air leak≥2 grade （OR=6.184, 95%CI: 2.048-18.674） and the level of CRP at first day after operation （OR=1.013, 95%CI: 1.000-1.025） were the independent risk factor of unscheduled hospital visiting in patients received VAST for pulmonary resections. The area under the ROC(AUC) curve of postoperative CRP was 0.618 （95%CI: 0.583-0.653, P=0.009）, with a cutoff value of 22.80mg/L; The AUC of the prediction model was 0.691 （95%CI: 0.657-0.724, P＜0.01）, with a cutoff value of 0.058. Conclusion Air leak≥2 grade and the level of CRP at first day after operation are independent risk factors of unplanned hospital visiting in patients undergoing VAST for pulmonary resections based on ERAS