Hospital Length of Stay After NSCLC Surgery Higher With Wildfire Exposure

In a conversation with CancerNetwork®, Leticia Nogueira, PhD, MPH, spoke about the rationale and key findings associated with her study assessing how wildfire exposure impacted surgical oncologists’ decisions on extending post-operative length of stay (LOS) for patients who undergo surgery for non–small cell lung cancer (NSCLC).1

According to Nogueira, scientific director of Health Services Research at the American Cancer Society, the inspiration for this research partly came from a prior study demonstrating worse overall survival outcomes among patients who are exposed to wildfires after being discharged from the hospital for lung cancer surgery.2 Additionally, data from her study showed that, on average, patients who received treatment at a facility exposed to wildfires had a longer LOS vs those who underwent surgery at facilities without wildfire exposure.

Among all patients in the study, the LOS was 7.45 days (SE, 0.22) for patients treated at facilities without wildfire exposure vs 9.42 days (SE, 0.25) among patients who received surgery at facilities exposed to wildfires (P <.0001).

Transcript:

The rationale for this study was [based on] a previous study where we found that patients who were exposed to a wildfire after they were discharged from the hospital following lung cancer surgery had worse mortality than unexposed patients. One question that we received a lot while we were discussing the results of that study was, “What can [doctors] do to protect these vulnerable people who are trying to recover from lung cancer surgery when there is a wildfire around them?”

Unfortunately, there were no clinical or even disaster guidelines that were specific for this population. But from talking to physicians and families, we saw that keeping the patients in the hospital for a couple of additional days was their best guess of what could be done. We decided to empirically test and conduct a study to see if, in the absence of guidelines— [because] there are no guidelines about what to do—would the physicians be implementing some of these improvisational strategies and keeping patients in the hospital a little longer anyways as their best guess of what could be done? That was the inspiration and the rationale for this study.

In this study, we found that patients who were recovering from lung cancer surgery when there was a wildfire in the area ended up staying in the hospital for an additional 2 days on average [compared with] similar patients—same age, same gender, and same type of tumor who received the exact same type of surgery—but [when] there was no wildfire around them. Patients who had a wildfire around them while they were in the hospital recovering from lung cancer surgery ended up staying an additional 2 days, compared with similar patients who were treated at the same facility, but at a time when there were no wildfires around. [These are] straightforward results.

References

1. Nogueira LM, Yabroff KR, Yates E, Shultz JM, Valdez RB, Nori-Sarma A. Facility exposure to wildfire disasters and hospital length of stay following lung cancer surgery. JNCI. Published online March 11, 2025. doi:10.1093/jnci/djaf040
2. Zhang D, Xi Y, Boffa DJ, et al. Association of wildfire exposure while recovering from lung cancer surgery with overall survival. JAMA Oncol 2023;9(9):1214-1220. doi:10.1001/jamaoncol.2023.2144