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Clinical Determinants Of Early Outcomes After Robotic Anatomic Lung Resection In The Eras Era
Ismail Sarbay, Gulnar Fatalizade, Alper Toker.
Istanbul Florence Nightingale Hospital, Istanbul, Turkey.
Background: Enhanced Recovery After Surgery (ERAS) protocols combined with robotic-assisted lung resection have enabled early mobilization, reduced length of stay (LOS), and low in-hospital morbidity. However, determinants of early postoperative outcomes, particularly hospital readmission in the ERAS era, remain incompletely understood. This study evaluated clinical and surgical factors associated with LOS, postoperative complications, and readmission following robotic lung resection.
Methods: All consecutive robotic anatomic lung resections performed between January to December 2025 following a standardized ERAS pathway were prospectively collected and retrospectively analyzed. Assessed variables included surgical complexity (complex vs non-complex), resection type (lobectomy, segmentectomy, wedge), neoadjuvant therapy, age, sex, and laterality. Early outcomes were LOS, postoperative complications, and hospital readmission. Univariate analyses were performed using non-parametric and categorical statistical tests.
Results: Ninety-four patients were included. Median LOS was 4 days (IQR 3-6). Postoperative complications (including all types of adverse events during the hospital stay) occurred in 33.0% of patients and were significantly associated with prolonged LOS (median 6 vs 4 days, p<0.001). Complication rates were comparable across resection types (p=0.63) and between complex and non-complex surgeries (p=0.51). Hospital readmission occurred in 5.3% of patients and was significantly higher after complex surgery compared with non-complex procedures (15.4% vs 1.5%, p=0.020). Readmission was not associated with resection type, LOS, in-hospital complications, neoadjuvant therapy, age, sex, or laterality.
Conclusions: In the ERAS era, robotic lung resection achieves low morbidity and short hospitalization even after complex procedures. However, surgical complexity emerges as a key determinant of hospital readmission, independent of in-hospital complications. These findings suggest that early outcomes after robotic lung surgery are shaped less by inpatient events and more by post-discharge vulnerability, highlighting the need for risk-adapted post-discharge surveillance rather than prolonged hospitalization.
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