Socioeconomic Status May Affect Discharge Timing After Lung Cancer Surgery

While patients who underwent lung cancer surgery can often return home a day after the operation thanks to protocols established in recent years, researchers found that patients with a lower socioeconomic status had a smaller chance of next-day discharge.

“Patients with low social-economic status identified by the ADI (area deprivation index) are not likely to be discharged the day after lung surgery. We can only speculate the reasons behind this observation. It is possible that patients with low social-economic status do not have the financial or social/family support needed to be home early after a major operation,” explained Dr. Dao Nguyen, Thoracic Cancers Group co-lead, Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine. “Without these supports, patients may feel unsafe to go home even though medically they are able to do so. Identifying this as a factor affecting the ability to discharge patient home on post-op day one allows us to focus our attention on these patients with low social-economic status in the preoperative period to explain to them what is needed to be discharged home early after thoracic surgery, to help them overcome their barriers and setup expectations.”

The study, which was published in the Journal of Thoracic and Cardiovascular Surgery Open, included 750 patients who were analyzed throughout a 10-year period to investigate the care protocols that are set in place by lung cancer surgeons within Sylvester Comprehensive Cancer Center.

The researchers focused on enhanced recovery after thoracic surgery (ERATS), a procedure to optimize a faster recovery and fewer complications. A total of 279 patients who received ERATS throughout the latest protocol period were observed in the study.

“It (ERATS) is a peri-operative care protocol specifically developed and implemented by our group based on the core requirements of the ERAS. Core requirements include: preoperative counseling and medical assessment to prepare patients for the upcoming operations; intraoperative cares to minimized surgical stress using minimally invasive surgical techniques and to mitigate postoperative nausea vomiting; and postoperative care with focus on mitigating pain, using multimodality pain management strategy to minimize opioid use and rapid restoration of bodily function, early ambulation and prevention of postoperative complications,” explained Nguyen.

Thanks to ERATS, patients tended to be discharged at a sooner rate, including many on post-operative day 1.

Drain removal, better opioid-sparing pain control, preoperative counseling to discuss realistic post-op expectations and home care arrangements, and regular, follow-up phone calls by nurse practitioners are the main factors as to how next day-discharge is available to patients, according to the authors of the study.

“The most relevant benefit is having patients home to their own comfort and familiar environment. They sleep better on their own bed, they don’t have to be disturbed by noise of the monitors and regular vital check by the nursing staff. And most important of all is the regain of their autonomy and independence. We have to do this safely and we prove it by our study published recently in the Journal of Thoracic and Cardiovascular Surgery, explained Nguyen. “There is no increase in re-admission or intervention for complications. there is no increase in the need for pain killer after discharge. Even though not included in our report, regular phone follow-up by our nurse practitioners have not identified any major complaints or issues with patients discharged early after a major lung cancer surgery.”

However, the researchers found that patients with a lower socioeconomic status experienced a 71% decrease of post-operative day 1 discharges.

Nguyen explained that it is beneficial for patients to meet with a specialist before making a decision on surgery.

“Patients with lung cancer should consult dedicated thoracic surgeons and medical oncologists specialized in and committed to the care for lung cancer patients at major academic centers such as Sylvester Cancer Center and UHealth of the University of Miami,” explained Nguyen.

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