Abstract
OBJECTIVES: Enhanced Recovery After Surgery aims to accelerate recovery, with length of stay as a key metric. This study assessed temporal trends in short-term outcomes within a maturing programme and identified factors associated with increased hospital stay. METHODS: Data were prospectively collected for consecutive patients undergoing lung cancer resection following a 14-step protocol between 2013 and 2023. Primary outcome was length of stay. Secondary outcomes included 30-day mortality, morbidity, re-admission, and reoperation rates. Predictors of length of stay were analysed using linear regression. RESULTS: We included 2192 patients; procedures included lobectomy (61%), wedge resection (23%), segmentectomy (10%), pneumonectomy (3.5%), and bi-lobectomy (2.7%), Video-assisted thoracoscopic surgery was used in 80% of cases. Median length of stay decreased from 5 to 4 days (p < 0.001), while protocol adherence increased from 10/14 to 12/14 (p = 0.01). In-hospital mortality (2.9% to 1.0%, p < 0.001) and major-morbidity (12.2% to 5.6%, p < 0.001) both declined. In multivariable linear regression, factors associated with longer stay included age (β = 0.17, CI 0.13-0.20, p < 0.001), higher American Society of Anesthesiologists score (β = 1.12, CI 1.04-2.2, p = 0.02), open surgery (β = 1.0, CI 0.17-2.2, p = 0.043), thoracoscopic-to-open converted surgery (β = 1.49, CI 0.96-1.9, p = 0.03) and intensive care (β = 3.4, CI 2.5-4.3, p < 0.001). Protective factors were early mobilisation (β=-0.90, CI -1.9-0.33, p = 0.005) and opioid avoidance (β=-0.72, CI -2.4-0.99, p = 0.038). CONCLUSIONS: Sustained use of an Enhanced Recovery After Surgery programme was associated with shorter hospitalisation and reduced morbidity. Factors associated with length of stay can identify patients at risk of delayed recovery and prioritise elements for optimisation within recovery pathways.