Association between length of stay and postoperative survival in patients with lung cancer: a propensity score matching analysis based on National Cancer Database

Weicheng Kong; Haoran Wang; Yanyan Chen; Juntao Xie; Binhao Huang; Liang Fang; Wenjuan Chen; Wei Shao; Jie Zhang

doi:10.21037/jtd-23-407

Association between length of stay and postoperative survival in patients with lung cancer: a propensity score matching analysis based on National Cancer Database

J Thorac Dis. 2023 Apr 28;15(4):1785-1793. doi: 10.21037/jtd-23-407. Epub 2023 Apr 26.

Authors

Weicheng Kong^#¹, Haoran Wang^#^{2

3}, Yanyan Chen^{4

5}, Juntao Xie⁶, Binhao Huang^{5

7}, Liang Fang⁸, Wenjuan Chen⁹, Wei Shao¹⁰, Jie Zhang^{3

5}

Affiliations

¹ Department of Thoracic Surgery, Putuo District People's Hospital, Zhoushan, China.
² Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.
³ Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁴ Division of Pulmonary, SinoUnited Health, Shanghai, China.
⁵ Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁶ Department of Surgery, Shanghai Putuo District People's Hospital, Shanghai, China.
⁷ Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
⁸ Department of General Medicine, Xinzhou District Second People's Hospital, Shangrao, China.
⁹ Department of Intensive Care Unit, Putuo District People's Hospital, Zhoushan, China.
¹⁰ Department of Interventional Therapy, Putuo District People's Hospital, Zhoushan, China.

^# Contributed equally.

Abstract

Background: Postoperative complications tend to result in prolonged hospitalization. The aim of this study was to investigate whether prolonged postoperative length of stay (LOS) can predict patient survival, particularly long-term survival.

Methods: All patients undergoing lung cancer surgery between 2004 and 2015 were identified in the National Cancer Database (NCDB). The highest quintile of LOS (more than 8 days) was defined as prolonged length of stay (PLOS). We performed 1:1 propensity score matching (PSM) between the groups with and without PLOS (Non-PLOS). Excluding confounding factors, postoperative LOS was used as a surrogate for postoperative complications. Kaplan-Meier and Cox proportional hazards survival analyses were performed to analyze survival.

Results: A total of 88,007 patients were identified. After matching, 18,585 patients were enrolled in the PLOS and Non-PLOS groups, respectively. Before and after matching, 30-day rehospitalization rate and 90-day mortality in the PLOS group were significantly higher than they were in the Non-PLOS group (P<0.001), indicating a potential worse short-term postoperative survival. After matching, the median survival of the PLOS group was significantly lower than that of the Non-PLOS group (53.2 vs. 63.5 months, P<0.0001). Multivariable analysis revealed that PLOS is independent negative predictor of overall survival [OS; hazard ratio (HR) =1.263, 95% confidence interval (CI): 1.227 to 1.301, P<0.001]. In addition, age (<70 or ≥70), gender, race, income, year of diagnosis, surgery type, pathological stage, and neoadjuvant therapy also were independent prognostic factors of postoperative survival for patients with lung cancer (all P<0.001).

Conclusions: Postoperative LOS could be taken as the quantitative indicator of postoperative complications of lung cancer in NCDB. In this study, PLOS predicted worse short-term and long-term survival independent of other factors. Avoiding PLOS could be considered to benefit patient survival after lung cancer surgery.

Keywords: Lung cancer; postoperative complications; postoperative survival; prolonged length of stay (PLOS).