P-103MOVING TOWARDS AN ULTRA-FAST TRACK MINIMALLY INVASIVE LOBECTOMY PATHWAY: A FEASIBILITY ANALYSIS
Bibliographic record
Abstract
Objectives: Video-assisted thoracoscopic (VATS) lobectomy has demonstrated several benefits over open surgery. The purpose of this study was to assess the feasibility and safety of short admissions for VATS lobectomy prior to implementation of an ultra-fast track pathway. Methods: All patients who underwent VATS lobectomy at our institution from 2006 to 2016 were retrospectively reviewed (n = 205). Clinicopathologic variables were collected along with perioperative outcomes. Patients discharged within 24 h (LOS1) were compared to those discharged on day 2 or later (LOS2+). Statistical analysis was done using Chi-square and t-test. Multivariate logistic regression was performed to identify predictors of LOS. Results: Perioperative 30-day mortality for our cohort was 0% and the major complication rate (Clavien-Dindo III-IV) was 8.3%. The median LOS was 3 days (IQR=2). 102(48.9%) patients were discharged within 48 h, and 34 within 24 h (LOS1=16.6%). None of these patients required re-admission (5.3% for LOS2+, P=0.17). LOS1 proportion increased in 2016 compared with previous years (25.8% vs 12.05%, P=0.05). Few differences existed between LOS1 and LOS2+ patients. Univariate analysis demonstrated that LOS2+ was associated with longer chest tube duration (OR = 4.9, 95% CI 0.2–11.2, P < 0.001), higher clinical (OR = 13.5, 95% CI 1.8–101, P=0.011) and pathological stage (OR = 3.9, 95% CI 1.1-13.5, P=0.035), presence of surgical complications (OR = 25.2, 95% CI 3.4–188, P=0.002), operative time >120 min (OR = 2.4, 95% CI 1.05–5.4, P=0.04), and air leak (OR = 26, 95% CI 1.6-438, P=0.02). Age, pulmonary function, smoking status and distance from the treatment centre were not associated with LOS. On multivariate analysis, longer chest tube duration (OR = 2.9, 95% CI 1.1–8.1, P=0.04), clinical stage (OR = 7.7, 95% CI 1.3–45, P=0.02), and surgical complications (OR = 17.9, 95% CI 1–327, P=0.05) were significant predictors of LOS2+. Conclusions: A significant proportion of patients can be discharged safely within 24 hours after VATS lobectomy. The only preoperative factor that predicts shorter LOS in our cohort is clinical stage. Thus, an ultra-fast track VATS lobectomy pathway is feasible and safe. Disclosure: No significant relationships.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".