Early ambulation and chest tube removal are associated with postoperative day one discharge in majority of robotic pulmonary lobectomy patients at an ERAS center

Background: Application of enhanced recovery after surgery (ERAS) pathways in robotic lobectomy have been associated with decreased length of stay (LOS). We evaluated differences in patient characteristics and achievements of ERAS benchmarks by discharge groups at a tertiary referral center.

Materials and methods: We performed a retrospective analysis of a prospectively maintained ERAS database of patients undergoing robotic lobectomy for pulmonary malignancy. Patients were trifurcated into LOS groups, postoperative day 1, 2-3, and 4+. Preoperative and perioperative variables, ERAS achievement, complications, and readmissions were analyzed.

Results: Between October 2018 and August 2022, 145 consecutive patients were reviewed. Eighty-two (56.6%) were discharged on POD 1, 50 (34.5%) on POD 2-3, and 13 (9.0%) on POD 4+. Patients achieving POD 1 discharge were associated with better preoperative pulmonary function (FEV₁ p = 0.023 and DLCO p = 0.007) and shorter operative times (p < 0.001). Most air leaks (n = 30, 54.5%) were resolved by discharge; however, 25 (17.2%) were discharged with a chest tube. The POD 1 discharge group ambulated earlier (p = 0.005) and experienced no inpatient complications. Multivariate analysis reveals that operative time, time to first ambulation, and postoperative day 1 air leak were negatively associated with POD 1 discharge. Those who experienced a minor inpatient complication ambulated 5.8 h later than those who did not.

Conclusion: Utilization of ERAS principles can facilitate POD 1 discharge in the majority of patients undergoing robotic assisted lobectomy without an increase in complications or readmissions. Early ambulation and chest tube removal are modifiable elements of ERAS associated with POD 1 discharge.