Psychosocial factors influencing the outcomes after major anatomical lung resections: a retrospective analysis of prospectively collected data

Length of stay (LOS) in hospital is a parameter often used to evaluate performance quality after surgery. However, other elements, not strictly related to surgical procedures might cause a prolongation of the hospitalization independently from the clinical outcome. This study aims to investigate whether psychosocial factors influence the LOS in hospital after major anatomical lung resections, integrating these non-clinical variables with the established confounders, among complicated and non-complicated patients. A prospectively maintained database on anatomical lung resections was retrospectively culled for data on pre-operative, intraoperative and postoperative variables. Along with clinical factors (sex, age, performance status, pulmonary function, metabolic and cardiovascular comorbidities, body mass index, surgical approach, histology, intercostal tube duration and complications), three psychosocial variables were included: "living alone", "pre-operative stress", "hobbies and interests". Multiple linear regression analysis was used to identify variables that contributed to prolong LOS. Subgroup analysis were performed based on complications. One hundred ninety-three patients were included 2020-2023. Sixty-seven patients (35%) experienced at least one complication. This condition was strongly associated with LOS in the multivariable analysis (P=0.002). Additionally, "living alone" (P=0.002) influenced the outcome, along with other clinical variables. Within the uncomplicated group, both "living alone" (P<0.001) and "pre-operative stress" (P=0.02) statistically significantly predicted LOS. In the complicated group, only reduced pulmonary function contributed to prolonged LOS. Psychosocial factors influence LOS and they should be accounted for. In particular, among patients without complications, stress or living alone affected LOS. These results suggest that the need for closer examination of patient backgrounds and may prove pivotal in directing health care system investments.