Safety and cost-effectiveness of day surgery in Da Vinci-assisted pulmonary segmentectomy.

Day surgery enhances resource utilization via enhanced recovery after surgery, but its role in robot-assisted pulmonary segmentectomy is unclear. This study assessed its safety, efficacy, and economic value to support broader clinical adoption. We retrospectively reviewed 341 patients who underwent Da Vinci robot-assisted pulmonary segmentectomy at our hospital between January 2021 and December 2024. Patients were divided into a day surgery group (N = 142) and an inpatient group (N = 199) based on perioperative management protocols following enhanced recovery after surgery (ERAS) principles, including preoperative assessment, inpatient care, and structured postoperative follow-up. Propensity score matching (1:1) with a caliper width set at 0.20 standard deviations was performed using covariates, including sex, age, radiological T stage, smoking history, prior thoracic/abdominal surgery, nodule location, segment complexity and lymph node dissection/sampling sites. After matching, 166 patients were analyzed for perioperative outcomes and postoperative complications. Compared with the inpatient group, the day surgery group had significantly less intraoperative blood loss [30 (30–50) vs. 50 (30–50) mL], shorter chest tube durations [38 (36–40) vs. 41 (39–65) hours], shorter hospital stays [47.0 (46.0–48.0) vs. 92.5 (84.3–111.8) hours], and lower total costs [8776 (6121–9769) vs. 12182 (10960–13474) USD] (all P < 0.05). No significant differences were observed in the operative time, drainage volume, pain score, postoperative complication rate, or 1-month pleural events (all P > 0.05). With standardized perioperative management, Da Vinci robot-assisted pulmonary segmentectomy performed as day surgery is safe, feasible, and cost effective. These findings support its further application in clinical thoracic surgical practice.