Surgeon Experience Is Associated With Prolonged Air Leak After Robotic-assisted Pulmonary Lobectomy
| Autor: | Syed M. Quadri, Cameron T. Stock, Lowell Su, Christina Williamson, Elliot L. Servais, Helen Ho |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Lung Neoplasms Logistic regression Postoperative Complications Robotic Surgical Procedures Diffusing capacity Humans Medicine Pneumonectomy Lung cancer Lung Retrospective Studies Surgeons Carbon Monoxide Thoracic Surgery Video-Assisted business.industry Odds ratio Perioperative medicine.disease humanities Surgery medicine.anatomical_structure Female Cardiology and Cardiovascular Medicine Complication business Body mass index |
| Zdroj: | The Annals of Thoracic Surgery. 114:434-441 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2021.07.033 |
| Popis: | Background Prolonged air leak (PAL) (>5 days) after robotic-assisted pulmonary lobectomy is a significant complication. This study aimed to determine patient- and surgeon-related factors that can predict PAL after robotic lobectomy for lung cancer. Methods This study was a retrospective review of a single-center experience of robotic-assisted lobectomy for lung cancer. Perioperative variables, including surgeon case experience, patient demographics, diffusion capacity of lung for carbon monoxide, forced expiratory volume in 1 second, body mass index, and smoking status were evaluated. Results A total of 305 robotic-assisted lobectomies performed by 4 surgeons met inclusion criteria from June 2016 to February 2019. The 30-day postoperative mortality was 1.2%. PAL developed in 27 of 305 (8.8%) patients. Surgeons’ robotic experience was grouped by 10-case increments. When adjusted for age and sex, the odds for PAL decreased by 15% for every 10 robotic lobectomies the surgeons performed (odds ratio [OR], 0.85; 95% CI, 0.74-0.99; P = .0384). Logistic regression models showed a linear transition curve at the 50th case. Female sex (OR, 2.62; 95% CI, 1.03-6.69; P = .0314) and younger age (OR, 0.61; 95% CI, 0.41-0.91; P = .0184) were statistically significant risk factors for PAL. Cumulative sum analysis similarly showed a strong association between experience and PAL. Preoperative diffusing capacity of lung for carbon monoxide, forced expiratory volume in 1 second, body mass index, and smoking status were not statistically significant predictive factors. Conclusions These results show that surgeon robotic case experience is associated with the rate of postoperative PAL: as the number of robotic lobectomies increases, the rate of PAL significantly decreases. It is imperative to emphasize that a learning curve exists for this approach that directly affects patient outcomes. |
| Databáze: | OpenAIRE |
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