Early Hospital Discharge on Day Two Post Robotic Lobectomy with Telehealth Home Monitoring: A Pilot Study

SIMPLE SUMMARY: Actually, the reported postoperative length of stay after robotic lobectomy is 4 days even in highly specialized centers. Several innovations have been recently introduced in the field of surgery to improve surgical outcome, between these the more remarkable is certainly the adoption of telemedicine. During the Coronavirus pandemic several wearable sensors and mobile applications were available to monitor physical and psychological parameters at home or in hospital. Despite this, perioperative telemonitoring is still rarely used in clinical practice, especially in thoracic surgery. Herein, we report the preliminary feasibility results of a pilot study for a protocol of early discharge (on day 2) with telehealth home monitoring after robotic lobectomy for cancer. During the study period, 10 patients satisfied all preoperative clinical and postoperative discharge criteria. No postoperative complication occurred neither readmission. Our preliminary results confirm as the integration of telehealth home monitoring in a fast-track protocol allows a safe discharge on postoperative day 2 after robotic surgery for cancer. The selection of patients is crucial for the success of this approach which remains applicable to VATS surgery too. A potential economic benefit for the health system could derive from this protocol if this data is confirmed in a larger sample. ABSTRACT: Despite the adoption of enhanced recovery programs, the reported postoperative length of stay after robotic surgery is 4 days even in highly specialized centers. We report preliminary results of a pilot study for a new protocol of early discharge (on day 2) with telehealth home monitoring after robotic lobectomy for lung cancer. All patients with a caregiver were discharged on postoperative day 2 with a telemonitoring device if they satisfied specific discharge criteria. Teleconsultations were scheduled once in the afternoon of post-operative day 2, twice on postoperative day 3, and then once a day until the chest tube removal. Post-discharge vital signs were recorded by patients at least four times daily through the device and were available for consultation by two surgeons through phone application. In case of sudden variation of vital signs or occurrence of adverse events, a direct telephone line was available for patients as well as a protected re-hospitalization path. Primary outcome was the safety evaluated by the occurrence of post-discharge complications and readmissions. Secondary outcome was the evaluation of resources optimization (hospitalization days) maintaining the standard of care. During the study period, twelve patients satisfied all preoperative clinical criteria to be enrolled in our protocol. Two of twelve enrolled patients were successively excluded because they did not satisfy discharge criteria on postoperative day 2. During telehealth home monitoring a total of 27/427 vital-sign measurements violated the threshold in seven patients. Among the threshold violations, only 1 out of 27 was a critical violation and was managed at home. No postoperative complication occurred neither readmission was needed. A mean number of three hospitalization days was avoided and an estimated economic benefit of about EUR 500 for a single patient was obtained if compared with patients submitted to VATS lobectomy in the same period. These preliminary results confirm that adoption of telemonitoring allows, in selected patients, a safe discharge on postoperative day 2 after robotic surgery for early-stage NSCLC. A potential economic benefit could derive from this protocol if this data will be confirmed in larger sample.