Background:There is mixed evidence supporting arrhythmia prophylaxis after lobectomy in patients not taking preoperative beta-blockers (BBs). We sought to determine the safety and efficacy of postoperative-BB versus diltiazem in BB-naïve patients in preventing post-lobectomy arrhythmia. Methods:This was a cohort study at one academic medical center (01/2019-03/2023). All patients undergoing elective lobectomy were included. Before May 2021, all patients undergoing lobectomy received low dose oral metoprolol postoperatively for arrhythmia prophylaxis. After May 2021, patients were started on oral diltiazem postoperatively unless they were receiving BB preoperatively, in which case their BB was continued. Patients were divided into pre-implementation versus post-implementation groups. The primary outcome was the rate of postoperative arrhythmia; secondary outcomes were the rates of postoperative heart failure, nonhome discharge, stroke and hypotension. Bivariable and multivariable logistic regression comparisons were performed. Results:In total, 606 patients were included; 318 patients (52.5%) were in the pre-implementation cohort. There were minimal differences in perioperative characteristics between groups. Patients in the post-implementation cohort had significantly lower rates of postoperative cardiac arrhythmias (5.2% vs. 9.7%, P=0.04). There were no differences in rates of postoperative cardiac failure/arrest, nonhome discharge, or stroke. After controlling for confounders, patients in the post-implementation cohort had lower risk-adjusted odds of postoperative arrhythmias (odds ratio 0.40, 95% confidence interval: 0.20-0.76) and hypotension (odds ratio 0.68, 95% confidence interval: 0.48-0.97). Conclusions:Patients had lower risk-adjusted rates of post-lobectomy arrhythmia and hypotension when using diltiazem for arrhythmia prevention compared to metoprolol. Our findings support the use of postoperative diltiazem preferentially in BB-naïve patients.

Background: The impact of surgeon subspecialty on postoperative outcomes is relatively unstudied in emergency thoracic surgery. The purpose of this study was to compare the outcomes of patients who undergo emergency thoracic operations by cardiothoracic surgeons versus other surgical subspecialties. Methods: This was a retrospective cohort using the National Surgical Quality Improvement Program database (2005-2018). A list of Current Procedural Terminology codes was generated by limiting the database to emergency operations performed by thoracic surgeons. Current Procedural Terminology codes occurring with frequency >10 were then used to search the entire database to identify patients who underwent emergency surgery by any surgeon specialty. Patients were grouped by operative surgeon primary subspecialty (cardiothoracic compared with other). Outcomes were compared using bivariable and multivariable regression analysis. Subgroup analysis was performed for lung and chest wall, hiatal hernia, esophagus, and pericardial operation-specific cohorts. Results: A total of 4,044 patients were included; 2,162 (53.5%) had emergency operations performed by cardiothoracic surgeons and 1,882 (46.5%) by other surgeons. Patients who underwent operations performed by cardiothoracic surgeons were more likely to have 6 of 18 medical comorbidities (all P < .05). Patients who had pericardial operations by cardiothoracic surgeons had lower risk-adjusted rates of mortality (odds ratio, 0.58; 95% confidence interval, 0.34-0.99), renal complications (odds ratio, 0.28; 95% confidence interval, 0.09-0.87), and bleeding (odds ratio, 0.45; 95% confidence interval, 0.24-0.84). There were no risk-adjusted differences in outcomes in the other subgroups. Conclusion: Patients who underwent emergency pericardial operations by cardiothoracic surgeons had improved postoperative outcomes compared with other surgeon specialties. These differences are important to consider when consulting surgeons for emergency thoracic operations. (c) 2025 Published by Elsevier Inc.

Background:Given the continued disruption of the coronavirus disease 2019 (COVID-19) pandemic throughout 2021, we aimed to assess for continued implications of the altered healthcare landscape on non-small cell lung cancer (NSCLC) presentation and treatment in the second year of the pandemic. Methods:This was a retrospective cohort study using the United States National Cancer Database (2019-2021). Demographic, cancer-related, and treatment variables were compared between patients diagnosed in the pre-pandemic year [2019], pandemic-year-one [2020], and pandemic-year-two [2021]. Multivariate logistic regression was performed to control for the impact of demographics on oncologic variables, and then for the impact of oncologic variables on treatment modalities and outcomes. Results:Of 376,193 NSCLC cases, 135,649 (36.1%) were pre-pandemic, 119,338 (31.7%) were pandemic-year-one, and 121,206 (32.2%) were pandemic-year-two. Compared to the pre-pandemic year, patients diagnosed in pandemic-year-two had risk-adjusted increases in clinical T stage [odds ratio (OR) =1.017; 95% confidence-interval (CI): 1.003-1.031], N stage (OR =1.048; 95% CI: 1.033-1.063), M stage (OR =1.044; 95% CI: 1.028-1.060), and overall stage (OR =1.038; 95% CI: 1.023-1.052). Additionally, compared to the pre-pandemic year, patients diagnosed in pandemic-year-two continue to see risk-adjusted increases in time from diagnosis to staging (OR =1.044; 95% CI: 1.017-1.072), to first treatment (OR =1.143; 95% CI: 1.133-1.154), to surgery (OR =1.117; 95% CI: 1.093-1.141) and to systemic therapy (OR =1.021; 95% CI: 1.924-1.039). Conclusions:Compared to the pre-pandemic year, patients diagnosed with NSCLC in the United States during pandemic-year-two continue to present at later clinical stage and experience delays to treatment. The oncologic and treatment characteristics of NSCLC have not returned to pre-pandemic baseline in the United States, possibly due to compounding delays to diagnosis and treatment and a growing back log of cases.

Timely surgical resection is an important component of treatment for non-small cell lung cancer (NSCLC). The Social Vulnerability Index (SVI) is a validated, composite metric for social determinants of health. This study aimed to determine whether social vulnerability is associated with delayed surgery for NSCLC. The study identified patients with stages IA to IIIA NSCLC who underwent upfront surgery between 2011 and 2021 in a single health care system. High social vulnerability was defined as SVI ≥ 75th percentile. Delayed surgery was defined as longer than 9 weeks after diagnosis. Unadjusted and risk-adjusted predictors of delayed surgery were identified. Time to surgery also was analyzed as a continuous variable. A negative binomial model was fitted to assess the individual impact of social vulnerability on time to surgery in days. Of 595 patients, 120 (20

Background:The number of people diagnosed with stage I-III non-small cell lung cancer (NSCLC) is increasing, in part due to greater implementation of lung cancer screening and earlier detection. Definitive surgery, radiation, or chemoradiation are increasingly utilized along with adjunctive therapies that include chemotherapy, radiation, immune checkpoint inhibitors (ICIs), and receptor tyrosine kinase inhibitors (rTKIs). However, remedial and adverse effects exist for each modality that must be accounted for in individual treatment plans with curative intent. The objective of this study was to characterize the benefits and harms of curative intent therapy using a novel patient-centered precision approach. Methods:We incorporated a precision medicine model to evaluate the benefits and harms using data from phase III randomized controlled trials (RCTs) or individual participant data meta-analyses of RCTs. We followed standard recommendations to assess benefit and harm with the absolute risk reduction (ARR) or absolute risk increase (ARI), and number needed-to-treat (NNT) for beneficial effect (NNTB) or NNT for harmful effect (NNTH). To measure the net effect of benefit and harm, we incorporated a novel summary statistic-the NNT for net effect (NNTnet), calculated as: 1/(ARR - ARI), or 1/(1/NNTB - 1/NNTH). We referenced guideline recommendations and interpreted results from the perspective of a hypothetical patient faced with choosing between treatment options; decision-making accounted for overall survival (OS) effects, what most patients have reported as acceptable mortality risk (≤2%) to gain 1 year of life, and guideline-endorsed treatment-associated mortality risk (≤5%). Results:We illustrated the NNTnet in screening and diagnosis. In definitive treatment, we identified: (I) overtreatment with lobectomy compared to segmentectomy in peripheral stage IA1-2 NSCLC (5-year OS: ARI, 3.2%; NNTH, 32); and (II) overtreatment with definitive tri-modality treatment for stage III NSCLC (i.e., induction chemoradiation followed by surgery), compared with concurrent chemoradiation without surgery, due to an excessively high 7-10% postoperative mortality with definitive tri-modality treatment and potential subsequent increased mortality within 1-year (two RCTs). In addition, we identified overtreatment with adjuvant radiation, compared to no adjuvant radiation, following complete resection of stage I-IIIB NSCLC (5-year OS: ARI, 5%; NNTB, 20) (14 RCTs). Furthermore, the harm of adjuvant radiation more than offsets the benefit of adjuvant chemotherapy (5-year OS: ARR, 4%; NNTB, 25): 1/(1/25 - 1/20), or -100. In other words, 100 patients treated with surgery and adjuvant radiation and chemotherapy, compared with surgery only, would result in one treatment-related death by 5 years. Finally, across four RCTs evaluating neoadjuvant chemo-ICI therapy, one in five participants with resectable IB-IIIA/B NSCLC did not subsequently receive curative surgery, resulting in potential undertreatment. Conclusions:This study has important implications in clinical decision-making and the design of future trials to prevent overtreatment or undertreatment, maximize benefits, minimize harms, and achieve net benefit over harm in beneficent care for this growing population.

Objective: Delays to definitive surgery in esophageal cancer may be associated with disease progression and worsened survival. The objective of this study was to perform a national assessment for predictors of delay to esophagectomy and to assess for their impact on oncologic and survival outcomes. Methods: The National Cancer Database, 2010 to 2020, was queried for patients with locally advanced esophageal adenocarcinoma (stage I-III). Patients were divided into up-front and postneoadjuvant chemoradiation cohorts. The primary outcome was time to surgery. Time to surgery was examined as a continuous and categorical variable, where patients were divided into timely and delayed cohorts (96 days for up-front cohort; 56 days for postneoadjuvant chemoradiation cohort). Results: Of 16,486 patients, 4066 (24.7%) underwent up-front surgery and 12,420 (75.3%) underwent postneoadjuvant chemoradiation surgery. In the up-front surgery group, median [interquartile range] time to surgery was 61 [40-96] days. Risk-adjusted predictors of delay included lack of insurance, lowest quartile of education, biopsy-based staging or surgical staging, and robotic-assisted approach. In the postneoadjuvant chemoradiation, cohort time to surgery was 55 [44-70] days. Risk-adjusted predictors of delay included Hispanic ethnicity, Medicaid or other government-based insurance, lowest quartile of educational status, and robotic approach. In the up-front surgery group, patients who received delayed surgery had increased odds of pathologic upstaging (1.31, 95% CI, 1.06-1.61). In the postneoadjuvant chemoradiation group, patients with surgical delay had increased odds of 90-day mortality (1.27, 95% CI, 1.06-1.51). Conclusions: After risk adjustment for patient, oncologic, facility, and surgical characteristics, there were several predictors of increased time to esophagectomy associated with consequences of upstaging and survival.

OBJECTIVES:Perioperative hypothermia, defined as a temperature <36.0°C, negatively impacts surgical outcomes. The purpose of this study was to evaluate the efficacy of a perioperative hypothermia prevention protocol for thoracic surgery with the aim of reducing incidence and improving outcomes. METHODS:A universal perioperative hypothermia prevention protocol was developed and implemented at 1 academic institution. All consecutive patients who underwent robotic-assisted thoracic surgery (RATS) pulmonary resection were included in the interventional cohort. Patient temperature, and change in temperature, were measured at 5 time points and across 4 intervals. Outcomes included the occurrence of 30-day overall morbidity and any infectious complications. Interventional cohort patients were compared to a historical control. RESULTS:Of 417 patients, 104 (24.9%) were in the intervention and 313 (75.1%) were in the historic control group. Patients in the intervention group had significantly decreased risk-adjusted odds of experiencing a temperature <36.0°C (odds ratio: 0.01 [95% confidence interval: 0.01-0.08]) or a temperature <35.0°C (0.06 [0.02-0.21]). Patients who had a temperature <35.5°C or <35.0°C had significantly increased risk-adjusted odds of overall morbidity (2.22 [1.18-4.17] and 2.17 [1.19-4.00]) and infectious morbidity (3.45 [1.52-8.33] and 3.23 [1.54-6.67]). CONCLUSIONS:Implementation of a thoracic perioperative hypothermia prevention protocol was associated with decreased risk-adjusted odds of hypothermia exposure with observed improvement in patient outcomes. IRB APPROVAL:COMIRB #22-2045, Approved 01/09/2023.

Objective: The objective of this study was to examine representation of women on the editorial boards of cardiothoracic surgery-focused journals over the past 2 decades to identify changes over time compared with women cardiothoracic surgeon and trainee representation, and to highlight additional opportunities for improvement. Methods: The editorial boards of 2 high-impact cardiothoracic surgery journals were reviewed from 2000 to 2023. Data on editorial board positions, including editors-in-chief, associate/deputy editors, feature editors, and general members of the editorial board were abstracted. The proportion of women editors was assessed. Data were compared with publicly available information from the Association of American Medical Colleges on physician specialty by sex. Results: Of 3460 editorial positions, 332 (9.6%) were held by women. Women occupied 2.2% (1 out of 45) of editor-in-chief positions, 13.2% (78 out of 592) of senior editor positions, 11.5% (33 out of 287) of feature editor positions, and 8.3% (221 out of 2663) of general editorial board positions. The proportion of women holding any editorial board position significantly increased from 2.4% in 2000 to 18.2% in 2023 (P = .01). Overall, editorial board representation increased at a rate of 0.7% +/- 1.3% per year, not significantly different from the growth of practicing women cardiothoracic surgeons at 0.3% +/- 0.5% per year (P = .584). Discussion: Representation of women on the editorial boards of cardiothoracic surgery-focused journals has increased commensurate with the increasing proportion of practicing women cardiothoracic surgeons, although remains at 16%. Work remains to continue the recruitment of women to cardiothoracic surgery as well as to identify the key elements that can support them in positions of leadership. (J Thorac Cardiovasc Surg 2025;169:691-8)

BACKGROUND:The first year of the COVID-19 pandemic significantly impacted the characteristics and care of esophageal cancer patients. We aimed to assess for continued implications of the altered healthcare landscape on esophageal cancer presentation and treatment in the second year of the pandemic. METHODS:This was a retrospective review of the United States National Cancer Database (2019-2021). Characteristics were compared between patients diagnosed in the pre-pandemic year (2019), pandemic-year-one (2020) and pandemic-year-two (2021). Multivariable risk-adjustment was performed. RESULTS:Of 41 807 esophageal cancer cases, 14 127 (35.3%) were pre-pandemic, 13 975 (32.7%) were pandemic-year-one, and 13 705 (32.0%) were pandemic-year-two. Compared to the pre-pandemic year, patients diagnosed in pandemic-year-two had risk-adjusted increases in time to first course treatment (1.06 [1.04-1.08]), to radiation (1.03 [1.01-1.05]), and to systemic therapy (1.04 [1.02-1.05]). When compared to pandemic-year-one, patients in pandemic-year-two continued to experience additional risk-adjusted increases in time to first course therapy (1.08 [1.06-1.11]), to surgery (1.05 [1.00-1.10]), to radiation (1.05 [1.02-1.07]) and to systemic therapy (1.06 [1.04-1.08]). CONCLUSIONS:Compared to the pre-pandemic year, patients diagnosed with esophageal cancer in in the United States during pandemic-year-two experienced delays to treatment, possibly due to a growing back log of cases.

Background: Parathyroidectomy remains the only definitive cure for primary hyperparathyroidism (PHPT). In rare cases, ectopic hyperfunctioning glands are located in the mediastinum, necessitating a thoracic surgical approach. The objective of this project was to review a single high-volume institutional experience of this presentation, with specific attention to the use of a robotic-assisted thoracic surgery (RATS) approach. Methods: This was a single-center, 5-year retrospective cohort study. All patients who underwent RATS mediastinal mass resection (MMR) for PHPT at the University of Colorado Anschutz Medical Campus were targeted for inclusion. Patient cases were reviewed for demographics, history, operative data, laboratory values, and postoperative course. Results: Eight patients underwent RATS-MMR for PHPT between 2018-2023. Median [interquartile range] operative time was 178 [138-213] minutes, and length of stay was 2.0 [1.5-2.0] days. One patient experienced post-operative chylothorax requiring dietary modification. There were no other 30-day complications or readmissions. Final pathology confirmed intrathymic parathyroid tissue in all patients. All patients achieved cure of PHPT. Conclusions: The robotic-assisted approach has low morbidity and associated hospital length of stay and can be safely used to cure PHPT. As this is a rare pathology with an infrequently utilized surgical approach, it is important to critically discuss the diagnostic evaluation and operative course, aimed at educating the thoracic surgeon who may encounter and assist in the management of these patients.

Abstract Background The COVID-19 pandemic significantly impacted the stage of presentation and subsequent therapies for patients who were diagnosed with esophageal cancer during the first pandemic year. We aimed to assess for continued implications of the altered healthcare landscape on esophageal cancer presentation and treatment in the second year of the pandemic. Methods This was a retrospective review of the United States National Cancer Database (2019-2021). Demographic, cancer-related and treatment variables were compared between patients diagnosed in the pre-pandemic year (2019), pandemic year one (2020) and pandemic year two (2021). Multivariate logistic regression was performed to control for the impact of demographics on oncologic variables, and then for the impact of oncologic variables on treatment modalities and outcomes. Results Of 42,807 esophageal cancer cases, 15,127 (35.3%) were pre-pandemic, 13,975 (32.7%) were pandemic year 1, and 13,705 (32.0%) were pandemic year two. There were significant differences in the distribution of clinical stage at presentation by year (p=0.0001), see figure, suggesting more advanced stage presentation throughout the pandemic. Compared to the pre-pandemic year, patients diagnosed in pandemic year two had risk-adjusted increases in time to first course treatment (incidence rate ratio 1.057 [95% confidence interval [1.036–1.078]), to radiation (1.029 [1.008–1.050]), and to systemic therapy (1.035 [1.018–1.051]). Additionally, when compared to pandemic year one, patients in pandemic year two continued to experience risk-adjusted increases in time to first course therapy (1.084 [1.063–1.106]), to surgery (1.049 [1.000–1.097]), to radiation (1.046 [1.024–1.068]) and to systemic therapy (1.060 [1.043–1.077]). Conclusions Compared to the pre-pandemic year, patients diagnosed with esophageal cancer in in the U.S. during pandemic year two continued to experience delays to treatment including delays to first course therapy, including delays to surgery, radiation and systemic therapy. The treatment characteristics of esophageal cancer have not returned to pre-pandemic baseline in the United States possibly due to compounding delays to diagnosis and treatment and a growing back log of cases.

Objective: We sought to evaluate how implementing a thoracic Enhanced Recovery After Surgery (ERAS) protocol impacted surgical outcomes after elective anatomic lung resection. Summary Background Data: The effect of implementing the ERAS Society/European Society of Thoracic Surgery (ESTS) thoracic ERAS protocol on postoperative outcomes throughout an entire healthcare system has not yet been reported. Methods: This was a prospective cohort study within one healthcare system (1/2019-3/2023). A thoracic ERAS protocol was implemented on 5/1/2021 for elective anatomic lung resections, and postoperative outcomes were tracked using the electronic health record and Vizient data. The primary outcome was overall morbidity; secondary outcomes included individual complications, length of stay (LOS), opioid use, chest tube duration, and total cost. Patients were grouped into pre- and post-ERAS cohorts. Bivariable comparisons were performed using independent t-test, chi-square, or Fisher’s exact tests, and multivariable logistic regression was performed to control for confounders. Results: There were 1,007 patients in the cohort; 450 (44.7%) were in the post-ERAS group. Mean age was 66.2 years; most patients were female (65.1%), white (83.8%), had a BMI between 18.5-29.9 (69.7%), and were ASA class 3 (80.6%). Patients in the post-implementation group had lower risk-adjusted rates of any morbidity, any respiratory complication, pneumonia, surgical site infection, arrhythmias, infections, opioid usage, ICU use, and shorter postoperative LOS (all P <0.05). Conclusions: Postoperative outcomes were improved after implementation of an evidence-based thoracic ERAS protocol throughout the healthcare system. This study validates the ERAS Society/ESTS guidelines and demonstrates that simultaneous multihospital implementation can be feasible and effective.

OBJECTIVES:Prior studies have associated morbidity following anatomic lung resection with prolonged postoperative length of stay; however, each complication's individual impact on length of stay as a continuous variable has not been studied. The purpose of this study was to determine the risk-adjusted increase in length of stay associated with each individual postoperative complications following anatomic lung resection. METHODS:Patients who underwent anatomic lung resection cataloged in the prospectively collected American College of Surgeons National Surgical Quality Improvement Program participant use file, 2005-2018, were targeted. The association between preoperative characteristics, postoperative complications and length of stay in days was tested. A negative binomial model adjusting for the effect of preoperative characteristics and 18 concurrent postoperative complications was used to generate incidence rate ratios. This model was fit to generate risk-adjusted increases in length of stay by complication. RESULTS:Of 32 133 patients, 5065 patients (15.8%) experienced at least one post-operative complication. The most frequent complications were pneumonia (n = 1829, 5.7%), the need for transfusion (n = 1794, 5.6%) and unplanned reintubation (n = 1064, 3.3%). The occurrence of each of the 18 individual complications was associated with significantly increased length of stay. This finding persisted after risk-adjustment, with the greatest risk-adjusted increases being associated with prolonged ventilation (+17.4 days), followed by septic shock (+17.2 days), acute renal failure (+16.5 days) and deep surgical site infection (+13.2 days). CONCLUSIONS:All 18 postoperative complications studied following anatomic lung resection were associated with significant risk-adjusted increases in length of stay, ranging from an increase of 17.4 days with prolonged ventilation to 2.6 days following the need for transfusion.

Background:Surgical diagnostic lung biopsy (DLB) is performed to guide the management of pulmonary disease with unclear etiology. However, the utilization of surgical DLB in critically ill patients remains unclear. The purpose of this study was to determine if patient preoperative disposition impacts complication rates after DLB.Methods:This was retrospective cohort study using electronic health record (EHR) data at one academic institution [2013-2021]. Patients who underwent DLB were identified using current procedural terminology (CPT) codes and cohorted based on preoperative disposition. The primary outcome was 30-day mortality; secondary outcomes were overall morbidity, individual complications, and changes to medical therapy. Complication rates were compared using chi-squared tests, Fisher's exact tests, or analysis of variance (ANOVA). Multivariable logistic regression was performed to generate risk-adjusted odds ratios (ORs) for each complication.Results:Of 285 patients, 238 (83.5%) presented from home, 26 (9.1%) from inpatient floor units, and 21 (7.4%) from intensive care units (ICUs). Patients requiring ICU had the highest 30-day rates of mortality, overall morbidity, and all individual complications (all P<0.05). After risk adjustment, non-ICU inpatients had higher odds of postoperative ventilator use, prolonged ventilation, and ICU need than outpatients (all P<0.05). Preoperative ICU disposition was associated with increased OR of 30-day mortality [OR, 70.92; 95% confidence interval (CI): 5.55-906.32] and overall morbidity (OR, 7.27; 95% CI: 1.93-27.42) compared to patients with other preoperative dispositions. There were no differences in changes to medical therapy between the cohorts.Conclusions:Patients requiring ICU before DLB had significantly higher risk-adjusted rates of mortality and postoperative complications than outpatients and other inpatients. A clear benefit from tissue diagnosis should be defined prior to performing DLB on critically ill patients.

Objective: Inadvertent perioperative hypothermia has been associated with poor surgical outcomes. The purpose of this study was to evaluate the incidence and associated postoperative complications of inadvertent perioperative hypothermia in patients undergoing robotic-assisted thoracic surgery lung resections. Methods: This was a single-center, retrospective cohort study evaluating all consecutive patients who underwent robotic-assisted thoracic surgery lung resection between January 1, 2021, and November 30, 2022. Temperatures were measured at 5 time points: preprocedure unit, anesthesia induction, 30 minutes postinduction, extubation, and recovery room arrival. Temperature changes were calculated at each interval. Adjusted and unadjusted comparison was performed between those who experienced varying levels of inadvertent perioperative hypothermia (Hypothermia I: <36 degrees C, Hypothermia II: <35.5 degrees C, and Hypothermia III: <35 degrees C) and those who did not. Results: A total of 313 patients were included, and 201 (64.2%) lobectomies, 50 (16.0%) segmentectomies, and 62 (19.8%) wedge resections were performed. Across all patients, 291 (93.0%) had a temperature less than 36 degrees C, 195 (62.3%) had a temperature less than 35.5 degrees C, and 100 (31.9%) had a temperature less than 35.0 degrees C. Patients experienced significant temperature change at all intervals (P < .001), with the greatest loss occurring during the preprocedure interval (between leaving preprocedure unit and anesthesia induction). On adjusted analysis, patients who experienced inadvertent perioperative hypothermia less than 35.5 degrees C were older (odds ratio, 1.03; 95% CI, 1.01-1.05), had lower body mass index (odds ratio, 0.95; 95% CI, 0.87-0.98), and had increasing operative time (odds ratio, 1.00; 95% CI, 1.00-1.01). Patients who experienced inadvertent perioperative hypothermia had higher risk-adjusted rates of overall morbidity and infectious postoperative complications. Conclusions: The majority of patients undergoing robotic-assisted thoracic surgery lung resections experience some degree of inadvertent perioperative hypothermia and have associated increased rates of 30-day morbidity. Structured and interval-specific interventions should be implemented to decrease rates of inadvertent perioperative hypothermia and subsequent complications.

Introduction: Compliance with thoracic Enhanced Recovery After Surgery (ERAS) protocols is critical to achieving their maximum benefits. We sought to examine utilization of quality review meetings as a method to improve protocol compliance through identification and resolution of barriers with compliance.Methods: A multidisciplinary committee implemented a thoracic ERAS protocol for anatomic lung resections across five hospitals within our health system. Compliance data at one institution were tracked for 4 mo after initiation of the ERAS protocol; a quality review meeting was held at one hospital, and two additional months of compliance data were recorded. Outcomes of interest were compliance changes to five protocol elements. Pathway elements deferred due to "mindful deviation" were excluded. Chi-square and Fisher's exact tests were used to compare compliance differences.Results: We included 81 patients: 53 patients before the quality review meeting and 28 after. There were 405 compliance opportunities; 68 (17%) were excluded for mindful deviation, leaving 337 (83%) for inclusion. Overall compliance improved from 53% before to 84% after the quality review meeting. Compliance to avoiding intraoperative urinary catheters, placing chest tubes to water seal in postanesthesia care unit, liberal chest tube removal, and postoperative multimodal pain regimen use improved after the quality review meeting (P values <0.05). Use of preoperative pain bundles was not significantly different (87% versus 96%, P = 0.25).Conclusions: Conducting a quality review meeting significantly improved ERAS protocol element use at our intervention healthcare region. This methodology should be considered at other institutions implementing surgical protocols.(c) 2023 Elsevier Inc. All rights reserved.

Patient-reported outcomes (PROs) are an underreported aspect of surgical recovery. The purpose of our study was to track PROs after robotic anatomic lung to determine the timing to recovery of baseline patient baseline quality of life. This was a prospective cohort study at an academic medical center (4/2021–12/2022). Patients who underwent robotic anatomic lung resection were asked to complete PROMIS-29 surveys at the preoperative clinic visit, postoperative clinic visit, 30 days and 90 days postoperatively via in-person and email-based electronic surveys. The PROPr score, a summary of health-related quality of life, and mental and physical health z-scores were estimated for each patient using published methods and compared by postoperative timing. 75 patients completed the preoperative survey and at least one postoperative survey; 56 completed postoperative clinic surveys, 54 completed 30-day postoperative surveys, and 40 completed 90-day postoperative surveys. All three PROMIS scores decreased between the preoperative and first postoperative visit (all p < 0.05). PROPr scores increased over time but remained significantly worse than baseline by 90 days (-0.08 difference between 90 days and preoperative, p = 0.02). While PROMIS summary z-scores for physical health remained − 0.29 lower at 90 days postoperatively, this did not reach statistical significance ( p = 0.06). Mental health scores returned to baseline by 90 days postoperatively ( p = 0.41). While some PROs returned to baseline by 90 days postoperatively, overall quality-of-life scores remained significantly below preoperative baselines. These findings are important to share with patients during the informed consent process to achieve patient centered care more effectively.

Background:The impact of post-surgical same day ambulation in lung resection patients is relatively unstudied. We sought to determine the relationship between day of surgery ambulation and postoperative outcomes after lung resection. Methods:This was a prospective cohort study at one healthcare system with six hospitals (1/2019-3/2023). Patients undergoing segmentectomy and lobectomy were targeted for inclusion. Patients who had missing ambulation data were excluded. Patients were divided into two cohorts based on whether or not they ambulated postoperatively on the day of surgery. Postoperative outcomes were compared using chi-square, Fisher's exact, or Mann-Whitney-U tests. Multivariable logistic regression controlling for pertinent perioperative confounders was performed to identify the independent effect of ambulation on complication rates. Results:Of 1,056 patients included in the analytic cohort, 443 patients (42.0%) ambulated postoperatively on the day of surgery. Patients who ambulated day of surgery had significantly lower rates of morbidity, including respiratory complications, surgical site infection, bleeding, cardiac complications, cardiac arrhythmias, infectious complications, and opioid use, and had shorter length of stay, shorter chest tube duration, and lower total hospital cost. After risk-adjustment, patients who ambulated day of surgery had lower odds of overall morbidity, less opioid consumption, shorter length of stay, and shorter chest tube duration. Conclusions:Patients who ambulated postoperatively on the day of surgery had better surgical recovery and outcomes after lung resection than those who did not. Day of surgery ambulation is an excellent quality metric and associated with avoidance of postoperative complications.