Time Trends of Perioperative Outcomes in Early Stage Non-Small Cell Lung Cancer Resection Patients.

Autor:	Shewale JB; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center, School of Public Health, Houston, Texas., Correa AM; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas., Brown EL; Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center, School of Public Health, Houston, Texas., Leon-Novelo LG; Department of Biostatistics and Data Science, University of Texas Health Science Center, School of Public Health, Houston, Texas., Nyitray AG; Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center, School of Public Health, Houston, Texas., Antonoff MB; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas., Hofstetter WL; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas., Mehran RJ; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas., Rice DC; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas., Walsh GL; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas., Roth J; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas., Vaporciyan AA; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas., Swisher SG; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas., Sepesi B; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: bsepesi@mdanderson.org.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2020 Feb; Vol. 109 (2), pp. 404-411. Date of Electronic Publication: 2019 Sep 17.
DOI:	10.1016/j.athoracsur.2019.08.018
Abstrakt:	Background: Advances in perioperative and operative management hold great promise for improving perioperative outcomes in patients undergoing resection for early stage non-small cell lung cancer (NSCLC). The objective of this study was to evaluate time trends in the incidence of perioperative outcomes and to identify predictors of pulmonary complication in early stage NSCLC resection patients. Methods: An institutional database was reviewed to identify patients with primary, clinical stage I and II NSCLC who underwent resection from 1998 to 2016. Rates of perioperative pulmonary complication, pneumonia, and cardiovascular complication; and 30-day and 90-day mortality were calculated for each year. Joinpoint regression was used to calculate annual percentage change (APC) and to evaluate time trends in rates of these outcomes. Multivariable logistic regression was conducted to identify predictors of pulmonary complication. Results: Of the 3045 patients identified, 80% had stage I and 20% had stage II NSCLC. From 1998 to 2016, there was no trend in the rate of pulmonary complication, but there was a significant downward trend in the rates of pneumonia (APC -3.7), cardiovascular complication (APC -3.5), 30-day mortality (APC -9.8), and 90-mortality (APC -7.4). Older age, male sex, smoking status, percentage of predicted forced expiratory volume in 1 second and percentage of diffusion capacity of lung for carbon monoxide, and intraoperative blood transfusion were identified as predictors of pulmonary complication. Conclusions: Decrease in the rates of perioperative outcomes parallels improvements in patient selection and perioperative management of early stage NSCLC resection patients. Predictors of pulmonary complication could be used to improve selection criteria for surgery and to reduce the incidence of pulmonary complication in these patients. (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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