Electronic patient-reported outcomes for outpatient care after non-intubated thoracic surgery in early-stage lung cancer.

BACKGROUND

Non-intubated thoracic surgery (NITS) is a promising alternative to conventional double-lumen endotracheal tube (DLT) surgery, aiming to reduce airway trauma and accelerate recovery. However, its impact on the patient's subjective experience, particularly after discharge, is not well-documented. This study aimed to compare the perioperative recovery and patient-reported outcomes between NITS and DLT surgery, utilizing electronic patient-reported outcomes (ePROs) as a key measurement tool for postoperative symptom surveillance.

METHODS

In this prospective, single-center cohort study, 60 patients scheduled for thoracoscopic resection between March and December 2023 were consecutively allocated to either the NITS group (n=30) or the DLT group (n=30). Both groups received standardized perioperative nursing care, while the NITS group additionally received targeted breathing training and enhanced intra-/postoperative respiratory support. ePROs covering nine symptom domains were collected daily during hospitalization and on postoperative days 7 and 30 after discharge. Conventional surgical metrics were also recorded. Between-group comparisons were performed using independent-samples t-tests or chi-square tests as appropriate.

RESULTS

Compared to the DLT group, NITS significantly reduced median hospital stay (3.47 vs. 5.37 days; P<0.001), chest tube duration (1.57 vs. 2.60 days; P=0.001), and drainage volume (49.7 vs. 71.0 mL; P=0.02). On postoperative day 7, NITS patients reported significantly lower scores for pain, cough, dyspnea, sleep disturbance, fatigue, somnolence, distress, mobility difficulty and activity limitation (all P≤0.001); improvements in cough, fatigue, somnolence, distress, and activity limitation remained significant at day 30 (all P<0.05).

CONCLUSIONS

NITS combined with enhanced recovery protocol is a feasible and safe approach that enhances early recovery while enabling proactive, personalized outpatient symptom management.