Abstract
OBJECTIVES: This study investigates factors affecting symptom severity at discharge in patients who have undergone lobectomy and sublobar resection via video-assisted thoracoscopic surgery for pulmonary nodules, including both benign and malignant cases. METHODS: This retrospective analysis utilized data from a patient cohort in a randomized controlled trial at Zhongshan City People's Hospital. Symptom severity was assessed using the validated Perioperative Symptom Assessment for Lung Surgery questionnaire at 4 time points. Patients were grouped by discharge-day symptoms: Alert (scores >3) and No Alert. Symptom scores were further compared between pathology subgroups: lung cancer and benign/others. Mann-Whitney tests and repeated measures analysis of variance were used to compare symptom trajectories between groups. Univariate and multivariate logistic regression analyses were employed to identify factors associated with symptom severity at discharge. RESULTS: Two hundred and forty-three patients were included in the analysis. The Alert group showed slower postoperative symptom improvement compared to the No Alert group (P < .05). Logistic regression analysis identified several key factors associated with symptom severity at discharge, including age, gender, smoking history, FEV1% (Forced Expiratory Volume in 1 second as a percentage of the predicted value), right upper lobe involvement, tumour stage, in-hospital complications, and length of stay after operation. In-hospital complications were significantly associated with increased severity of symptoms at discharge, including disturbed sleep, fatigue, drowsiness, and sadness. CONCLUSIONS: Multiple patient-specific and surgical factors influence postoperative symptom severity at discharge. These findings identify key factors associated with symptom severity and may inform future personalized management strategies following lung surgery. CLINICAL REGISTRATION NUMBER: ClinicalTrials.gov; NCT05990946; https://clinicaltrials.gov/study/NCT05990946.