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Background: Consensus guidelines regarding the amount and necessity of post-operative imaging in thoracic surgery are lacking. The efficacy of daily chest radiographs (CXR) following video-assisted (VATS) and robotic-assisted (RATS) thoracoscopic surgery in directing management has not been previously studied. We hypothesize that abnormal clinical findings, rather than abnormal imaging findings, better predict post-operative complications in patients undergoing VATS/RATS lobectomies. Methods: A retrospective review of VATS and RATS lobectomy patients were performed at a tertiary referral center from 1/1/2019–12/31/2021. Demographics, hospital course, and imaging were evaluated. Descriptive statistics, Chi-Square test, Fisher's exact, Wilcoxon rank sum, and multivariable logistic regression were performed. Our outcomes were post-operative complications requiring a procedure and extended length of stay (LOS) (>2 days post-operatively). Results: Out of 362 VATS/RATS lobectomy patients, 15 patients had post-operative complications requiring a procedure. Almost all patients who required a procedure had abnormal clinical signs and symptoms (14/15; p

Background: Disparities exist throughout surgery. We aimed to assess for racial/ethnic disparities among outcomes in a large thoracic surgery patient population. Methods: We reviewed all thoracic surgery patients treated at our integrated health system from January 1, 2016–December 31, 2020. Post-operative outcomes including length of stay (LOS), 30-day return to the emergency department (30d-ED), 30-day readmission, 30- and 90-day outpatient appointments, and 30- and 90-day mortality were compared by race/ethnicity. Bivariate analyses and multivariable logistic regression were performed. Our multivariable models adjusted for age, sex, body mass index, Charlson Comorbidity Index, surgery type, neighborhood deprivation index, insurance, and home region. Results: Of 2730 included patients, 59.4 % were non-Hispanic White, 15.0 % were Asian, 11.9 % were Hispanic, 9.6 % were Black, and 4.1 % were Other. Median (Q1-Q3) LOS (in hours) was shortest among non-Hispanic White (37.3 (29.2–76.1)) and Other (36.5 (29.3–75.4)) patients followed by Hispanic (46.8 (29.9–78.1)) patients with Asian (51.3 (30.7–81.9)) and Black (53.7 (30.6–101.6)) patients experiencing the longest LOS (p

BackgroundEsophagectomy, an esophageal cancer treatment mainstay, is a highly morbid procedure. Prolonged operative time, only partially predetermined by case complexity, may be uniquely harmful to minimally-invasive esophagectomy (MIE) patients for numerous reasons, including anastomotic leak, tenuous conduit perfusion and protracted single-lung ventilation, but the impact is unknown. This multi-center retrospective cohort study sought to characterize the relationship between MIE operative time and post-operative outcomes.MethodsWe abstracted multi-center data on esophageal cancer patients who underwent MIE from 2010 to 2021. Predictor variables included age, sex, comorbidities, body mass index, prior cardiothoracic surgery, stage, and neoadjuvant therapy. Outcomes included complications, readmissions, and mortality. Association analysis evaluated the relationship between predictor variables and operative time. Multivariate logistic regression characterized the influence of potential predictor variables and operative time on post-operative outcomes. Subgroup analysis evaluated the association between MIE >4 h vs. ≤4 h and complications, readmissions and survival.ResultsFor the 297 esophageal cancer patients who underwent MIE between 2010 and 2021, the median operative duration was 4.8 h [IQR: 3.7–6.3]. For patients with anastomotic leak (5.1%) and 1-year mortality, operative duration was elevated above the median at 6.3 h [IQR: 4.8–8.6], p = 0.008) and 5.3 h [IQR: 4.4–6.8], p = 0.04), respectively. In multivariate logistic regression, each additional hour of operative time increased the odds of anastomotic leak and 1-year mortality by 39% and 19%, respectively.ConclusionsEsophageal cancer is a poor prognosis disease, even with optimal treatment. Operative efficiency, a modifiable surgical variable, may be an important target to improve MIE patient outcomes.

Introduction: There is no consensus on postoperative thoracostomy tube management in thoracic patients, specifically whether or not a chest radiograph is required after tube removal. Methods: Retrospective review of video-assisted thoracoscopic (VATS) lobectomy patients was performed at a large tertiary referral center from January 1, 2019 to December 31, 2020. Patients were grouped as asymptomatic or symptomatic after thoracostomy removal. Demographic data and clinical outcomes were evaluated. Descriptive statistics, Fisher's exact and Wilcoxon rank sum tests were performed. Results: 202 of 208 patients were asymptomatic after thoracostomy removal. Demographic data between those who were asymptomatic and symptomatic revealed no differences except for a higher FEV1/FVC in the asymptomatic group. Median length of stay for asymptomatic and symptomatic patients was 2.0 and 3.5 (p=0.295). 62% of asymptomatic versus 100% of symptomatic patients had abnormal post-pull radiographs (p=0.088). No one in the asymptomatic group required an intervention after thoracostomy removal and prior to discharge whereas 66.7% in the symptomatic group required a procedure (p

Introduction: Faster time to ambulation (TTA) after video assisted thoracoscopic surgery (VATS) is associated with improved outcomes. We hypothesized that reduced urinary catheter duration leads to shorter TTA after VATS lobectomy. Methods: We studied VATS lobectomy patients from 2014 through 2018. TTA of patients that did not have urinary catheters or whose catheters were removed at the end of the operation (reduced cath) was compared to TTA of those whose catheters were removed the day after surgery (long cath). Results: Overall, 67 and 234 patients were included in the reduced cath and long cath groups, respectively. Median TTA was shorter in the reduced cath group compared to the long cath group (6.5 h Q1-Q3: 4.8-10.7 vs 11.0 h Q1-Q3: 6.8-18.3, p