This article describes common obstacles to successful early discharge that face many thoracic surgeons despite technically successful procedures; these obstacles include inadequate pain control, prolonged air leaks, and social issues. With continually increasing health care costs and limited resources, identifying the factors that affect length of stay has taken on new importance. Potential solutions that also maintain the quality of patient care are discussed and include the use of minimally invasive techniques, optimizing pain control, early mobilization, discharge planning, patient education, and the development of clinical pathways.