The cost and efficacy of ambulatory and hospitalized surgical resection in patients with lung tumors: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Shanshan , WANG Yue ,  MA Haiping

Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830013, P. R. China;

Corresponding?author：

MA Haiping, Email: 1378016084@qq.com

Keywords：

Lung neoplasms; ambulatory surgery; efficacy; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202504080

Video：

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Objective To compare the cost and efficacy of ambulatory versus hospitalized surgery for lung tumor patients. Methods Two researchers independently conducted a computer search on February 14, 2025, in databases including CNKI, PubMed, Web of Science, Ovid Medline, Cochrane Library, and Wanfang Database, with the search period covering from the inception of these databases to February 2025. The outcome indicators were postoperative complication rate, length of hospital stay, hospitalization costs, et al. For the included randomized controlled trials and non-randomized controlled trials, we used the Cochrane risk of bias assessment tool and the Newcastle Ottawa Scale (NOS) respectively to evaluate the quality of the literature, and extracted data from the included studies for meta-analysis using RevMan 5.4 and Stata 18.0. Results A total of 12 researches were ultimately included, consisting of 2 randomized controlled trials, 2 prospective cohort studies, and 8 retrospective cohort studies, involving a total of 76 403 patients. All researches were evaluated as high-quality. Meta-analysis showed that the ambulatory surgery group had advantages over the hospitalized surgery group in terms of operation time [MD=?21.07, 95%CI (?30.55, ?11.58), P<0.001], length of hospital stay [MD=?2.17, 95%CI (?3.25, ?1.09), P<0.001], hospitalization costs [SMD=?1.22, 95%CI (?2.18, ?0.26), P=0.01], and overall postoperative complications [OR=0.48, 95%CI (0.32, 0.74), P<0.001]. There was no statistically significant difference between the two groups in terms of postoperative hoarseness [OR=0.62, 95%CI (0.24, 1.61), P=0.33] and postoperative chylothorax [OR=0.27, 95%CI (0.07, 1.07), P=0.06]. Conclusion Compared to conventional hospitalized lung tumor resection, ambulatory lung tumor resection can significantly reduce the patient’s surgery and hospital stay time, decrease hospitalization costs, and reduce the incidence of postoperative complications. Ambulatory surgery can improve hospital efficiency while reducing the economic burden on patients. It is worthy of further promotion and application.

1.	Leiter A, Veluswamy RR, Wisnivesky JP. The global burden of lung cancer: current status and future trends. Nat Rev Clin Oncol, 2023, 20(9): 624-639.
2.	Wu FY, Wang L, Zhou CC. Lung cancer in China: current and prospect. Curr Opin Oncol, 2020, 33(1): 40-46.
3.	劉靜. DRG/DIP醫保政策改革下醫院服務質量與提升策略. 四川勞動保障, 2025, 2(2): 95-96.Liu J. Hospital service quality and improvement strategies under DRG/DIP medical insurance policy reform. Labor Soc Secur, 2025, 2(2): 95-96.
4.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
5.	吳柔娜, 晁敏, 毛琳. 加速康復外科在我國的研究現狀及展望. 加速康復外科雜志, 2022, 5(3): 123-129.Wu RN, Chao M, Mao L. Application situation and prospect of enhanced recovery after surgery in China. J Enhanc Recov After Surg, 2022, 5(3): 123-129.
6.	錢玥, 馬正良. 快速康復外科理念下日間手術的麻醉與圍術期質量控制. 實用醫學雜志, 2024, 40(8): 1042-1046.Qian Y, Ma ZL. Anesthesia and perioperative quality control of ambulatory surgery under the concept of rapid recovery surgery. J Pract Med, 2024, 40(8): 1042-1046.
7.	李龍, 焦作義, 羅長江. 日間手術腹腔鏡膽囊切除術療效和安全性的Meta分析. 中華普通外科學文獻(電子版), 2018, 12(6): 444-450.Li L, Jiao ZY, Luo CJ. Ambulatory surgery for laparoscopic cholecystectomy: a meta-analysis. Chin Arch Gen Surg (Electron Ed), 2018, 12(6): 444-450.
8.	李雪, 胡成云, 周婉君, 等. ERAS理念下日間手術麻醉研究進展(綜述). 安徽醫專學報, 2024, 23(1): 32-35.Li X, Hu CY, Zhou WJ, et al. Research progress on anesthesia management in patients undergoing day surgery with ERAS (Review). J Anhui Med Coll, 2024, 23(1): 32-35.
9.	肺癌手術日間化管理中國專家共識(2024年版). 中國肺癌雜志, 2024, 27(6): 405-414.Chinese expert consensus on day surgery management of lung cancer (2024 edition). Chin J Lung Cancer, 2024, 27(6): 405-414.
10.	Shen C, Che GW. Thoracic day surgery versus thoracic inpatient surgery for treatment of patients with lung cancer: a systematic review and meta-analysis. J Cardiothorac Surg, 2023, 18(1): 341.
11.	Wang X, Wang WQ, Li JM, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014, 14(1): 135.
12.	José JY, Gerard U, Marta R, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol (Engl Ed), 2021, 74(9): 790-799.
13.	Sterne JAC, Savovi? J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
14.	Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Accessed on March 29, 2025.
15.	Ding Y, Zhou L, Shan L, et al. Video-assisted thoracoscopic lung resection with or without enhanced recovery after surgery: a single institution, prospective randomized controlled study. Front Oncol, 2024, 14: 1474438.
16.	Dong YX, Zhu DJ, Che GW, et al. Clinical effect of day surgery in patients with lung cancer by optimize operating process. Chin J Lung Cancer, 2020, 23(2): 77-83.
17.	Dong YX, Shen C, Wang Y, et al. Safety and feasibility of video-assisted thoracoscopic day surgery and inpatient surgery in patients with non-small cell lung cancer: a single-center retrospective cohort study. Front Surg, 2021, 8: 779889.
18.	Drawbert HE, Hey MT, Tarrazzi F, et al. Early discharge on postoperative day 1 following lobectomy for stage I non-small-cell lung cancer is safe in high-volume surgical centres: a national cancer database analysis. Eur J Cardiothorac Surg, 2021, 61(5): 1022-1029.
19.	Geraci TC, Chang SH, Chen S, et al. Discharging patients by postoperative day one after robotic anatomic pulmonary resection. Ann Thorac Surg, 2021, 114(1): 234-240.
20.	Linden AP, Perry Y, Worrell S, et al. Postoperative day 1 discharge after anatomic lung resection: a Society of Thoracic Surgeons database analysis. J Thorac Cardiovasc Surg, 2019, 159(2): 667-678. e2.
21.	Patel DC, Leipzig M, Jeffrey Yang CF, et al. Early discharge after lobectomy for lung cancer does not equate to early readmission. Ann Thorac Surg, 2021, 113(5): 1634-1640.
22.	Towe CW, Khil A, Ho VP, et al. Early discharge after lung resection is safe: 10-year experience. J Thorac Dis, 2018, 10(10): 5870-5878.
23.	Wang C, Lai Y, Li P, et al. Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1749 cases. BMC Surg, 2021, 21(1): 115.
24.	Young AM, Viktorsson SA, Strobel RJ, et al. Five-year sustained impact of a thoracic enhanced recovery after surgery program. Ann Thorac Surg, 2024, 117(2): 422-430.
25.	Zhang G, Fan J, Yu Z, et al. Video-assisted thoracoscopic treatment as two-day surgery for lung neoplasms: a propensity-matched analysis. BMC Cancer, 2022, 22(1): 832.
26.	Zhang H, Chen W, Wang J, et al. Real-world study on the application of enhanced recovery after surgery protocol in video-assisted thoracoscopic day surgery for pulmonary nodule resection. BMC Surg, 2024, 24(1): 288.
27.	馬正良, 黃宇光, 顧小萍, 等. 成人日間手術加速康復外科麻醉管理專家共識. 協和醫學雜志, 2019, 10(6): 562-569.Ma ZL, Huang YG, Gu XP, et al. Expert consensus on anesthesia management of enhanced recovery after adult ambulatory surgery. Med J Peking Union Med Coll Hosp, 2019, 10(6): 562-569.
28.	四川天府新區醫學會日間護理專業委員會. 日間手術病房"平急結合"管理模式專家共識. 華西醫學, 2024, 39(2): 173-177.Day Surgery Nursing Committee of Sichuan Tianfu New Area Medical Association. Expert consensus on the management model of integrating emergency and routine medical care in day surgery wards. West China Med J, 2024, 39(2): 173-177.
29.	魯發順, 鐘鍇, 穆熱艾合買提江·穆塔里夫, 等. 日間模式應用于腹腔鏡膽囊切除術的療效分析. 中國普外基礎與臨床雜志, 2021, 28(7): 856-860.Lu FS, Zhong K, Mureaihemaitijiang M, et al. Curative effect analysis of ambulatory pattern in laparoscopic cholecystectomy. Chin J Bases Clin Gen Surg, 2021, 28(7): 856-860.
30.	徐建國. 成人日間手術后鎮痛專家共識(2017). 臨床麻醉學雜志, 2017, 33(8): 812-815.Xu JG. Expert consensus on postoperative analgesia in adult day surgery (2017). J Clin Anesthesiol, 2017, 33(8): 812-815.
31.	Ng L, Mercer-Jones M. Day case surgery guidelines. Surgery (Oxford), 2014, 32(2): 73-78.

1. Leiter A, Veluswamy RR, Wisnivesky JP. The global burden of lung cancer: current status and future trends. Nat Rev Clin Oncol, 2023, 20(9): 624-639.
2. Wu FY, Wang L, Zhou CC. Lung cancer in China: current and prospect. Curr Opin Oncol, 2020, 33(1): 40-46.
3. 劉靜. DRG/DIP醫保政策改革下醫院服務質量與提升策略. 四川勞動保障, 2025, 2(2): 95-96.Liu J. Hospital service quality and improvement strategies under DRG/DIP medical insurance policy reform. Labor Soc Secur, 2025, 2(2): 95-96.
4. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
5. 吳柔娜, 晁敏, 毛琳. 加速康復外科在我國的研究現狀及展望. 加速康復外科雜志, 2022, 5(3): 123-129.Wu RN, Chao M, Mao L. Application situation and prospect of enhanced recovery after surgery in China. J Enhanc Recov After Surg, 2022, 5(3): 123-129.
6. 錢玥, 馬正良. 快速康復外科理念下日間手術的麻醉與圍術期質量控制. 實用醫學雜志, 2024, 40(8): 1042-1046.Qian Y, Ma ZL. Anesthesia and perioperative quality control of ambulatory surgery under the concept of rapid recovery surgery. J Pract Med, 2024, 40(8): 1042-1046.
7. 李龍, 焦作義, 羅長江. 日間手術腹腔鏡膽囊切除術療效和安全性的Meta分析. 中華普通外科學文獻(電子版), 2018, 12(6): 444-450.Li L, Jiao ZY, Luo CJ. Ambulatory surgery for laparoscopic cholecystectomy: a meta-analysis. Chin Arch Gen Surg (Electron Ed), 2018, 12(6): 444-450.
8. 李雪, 胡成云, 周婉君, 等. ERAS理念下日間手術麻醉研究進展(綜述). 安徽醫專學報, 2024, 23(1): 32-35.Li X, Hu CY, Zhou WJ, et al. Research progress on anesthesia management in patients undergoing day surgery with ERAS (Review). J Anhui Med Coll, 2024, 23(1): 32-35.
9. 肺癌手術日間化管理中國專家共識(2024年版). 中國肺癌雜志, 2024, 27(6): 405-414.Chinese expert consensus on day surgery management of lung cancer (2024 edition). Chin J Lung Cancer, 2024, 27(6): 405-414.
10. Shen C, Che GW. Thoracic day surgery versus thoracic inpatient surgery for treatment of patients with lung cancer: a systematic review and meta-analysis. J Cardiothorac Surg, 2023, 18(1): 341.
11. Wang X, Wang WQ, Li JM, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014, 14(1): 135.
12. José JY, Gerard U, Marta R, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol (Engl Ed), 2021, 74(9): 790-799.
13. Sterne JAC, Savovi? J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
14. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Accessed on March 29, 2025.
15. Ding Y, Zhou L, Shan L, et al. Video-assisted thoracoscopic lung resection with or without enhanced recovery after surgery: a single institution, prospective randomized controlled study. Front Oncol, 2024, 14: 1474438.
16. Dong YX, Zhu DJ, Che GW, et al. Clinical effect of day surgery in patients with lung cancer by optimize operating process. Chin J Lung Cancer, 2020, 23(2): 77-83.
17. Dong YX, Shen C, Wang Y, et al. Safety and feasibility of video-assisted thoracoscopic day surgery and inpatient surgery in patients with non-small cell lung cancer: a single-center retrospective cohort study. Front Surg, 2021, 8: 779889.
18. Drawbert HE, Hey MT, Tarrazzi F, et al. Early discharge on postoperative day 1 following lobectomy for stage I non-small-cell lung cancer is safe in high-volume surgical centres: a national cancer database analysis. Eur J Cardiothorac Surg, 2021, 61(5): 1022-1029.
19. Geraci TC, Chang SH, Chen S, et al. Discharging patients by postoperative day one after robotic anatomic pulmonary resection. Ann Thorac Surg, 2021, 114(1): 234-240.
20. Linden AP, Perry Y, Worrell S, et al. Postoperative day 1 discharge after anatomic lung resection: a Society of Thoracic Surgeons database analysis. J Thorac Cardiovasc Surg, 2019, 159(2): 667-678. e2.
21. Patel DC, Leipzig M, Jeffrey Yang CF, et al. Early discharge after lobectomy for lung cancer does not equate to early readmission. Ann Thorac Surg, 2021, 113(5): 1634-1640.
22. Towe CW, Khil A, Ho VP, et al. Early discharge after lung resection is safe: 10-year experience. J Thorac Dis, 2018, 10(10): 5870-5878.
23. Wang C, Lai Y, Li P, et al. Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1749 cases. BMC Surg, 2021, 21(1): 115.
24. Young AM, Viktorsson SA, Strobel RJ, et al. Five-year sustained impact of a thoracic enhanced recovery after surgery program. Ann Thorac Surg, 2024, 117(2): 422-430.
25. Zhang G, Fan J, Yu Z, et al. Video-assisted thoracoscopic treatment as two-day surgery for lung neoplasms: a propensity-matched analysis. BMC Cancer, 2022, 22(1): 832.
26. Zhang H, Chen W, Wang J, et al. Real-world study on the application of enhanced recovery after surgery protocol in video-assisted thoracoscopic day surgery for pulmonary nodule resection. BMC Surg, 2024, 24(1): 288.
27. 馬正良, 黃宇光, 顧小萍, 等. 成人日間手術加速康復外科麻醉管理專家共識. 協和醫學雜志, 2019, 10(6): 562-569.Ma ZL, Huang YG, Gu XP, et al. Expert consensus on anesthesia management of enhanced recovery after adult ambulatory surgery. Med J Peking Union Med Coll Hosp, 2019, 10(6): 562-569.
28. 四川天府新區醫學會日間護理專業委員會. 日間手術病房"平急結合"管理模式專家共識. 華西醫學, 2024, 39(2): 173-177.Day Surgery Nursing Committee of Sichuan Tianfu New Area Medical Association. Expert consensus on the management model of integrating emergency and routine medical care in day surgery wards. West China Med J, 2024, 39(2): 173-177.
29. 魯發順, 鐘鍇, 穆熱艾合買提江·穆塔里夫, 等. 日間模式應用于腹腔鏡膽囊切除術的療效分析. 中國普外基礎與臨床雜志, 2021, 28(7): 856-860.Lu FS, Zhong K, Mureaihemaitijiang M, et al. Curative effect analysis of ambulatory pattern in laparoscopic cholecystectomy. Chin J Bases Clin Gen Surg, 2021, 28(7): 856-860.
30. 徐建國. 成人日間手術后鎮痛專家共識(2017). 臨床麻醉學雜志, 2017, 33(8): 812-815.Xu JG. Expert consensus on postoperative analgesia in adult day surgery (2017). J Clin Anesthesiol, 2017, 33(8): 812-815.
31. Ng L, Mercer-Jones M. Day case surgery guidelines. Surgery (Oxford), 2014, 32(2): 73-78.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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