High-risk patients and postoperative complications following video-assisted thoracic surgery lobectomy: a case-matched comparison with lower-risk counterparts
| Autor: | Nilanjan Chaudhuri, Alberto Sandri, Vasileios Tentzeris, Cecilia Pompili, Emmanuel Kefaloyannis, Alessandro Brunelli, Richard Milton, Kostas Papagiannopoulos |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Lung Neoplasms VATS lobectomy Lower risk Preoperative care Coronary artery disease Risk Factors DLCO Humans Medicine Pneumonectomy Propensity Score Aged Retrospective Studies Performance status Thoracic Surgery Video-Assisted business.industry Incidence (epidemiology) Mortality rate Middle Aged medicine.disease Survival Analysis Surgery Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Interactive CardioVascular and Thoracic Surgery. :ivv254 |
| ISSN: | 1569-9285 1569-9293 |
| DOI: | 10.1093/icvts/ivv254 |
| Popis: | To assess the postoperative incidence of major complications in high-risk patients following video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer compared with their lower risk counterparts.A retrospective analysis on prospectively collected data of 348 consecutive patients subjected to VATS lobectomy (August 2012-September 2014) was performed. Patients were defined as high risk if one or more of the following characteristics were present: age75 years, forced expiratory volume in 1 s (FEV1)50%, carbon monoxide lung diffusion capacity (DLCO)50%, history of coronary artery disease (CAD). Severity of complications was graded using the Thoracic Morbidity and Mortality (TMM) score; major complications were defined if the TMM score was greater than 2. The propensity score was used to match high-risk patients with their lower risk counterparts in order to minimize the influence of other confounders on outcome. The following variables were used to construct the propensity score: gender, side of operation, body mass index, American Society of Anaesthesiologists score, Eastern Cooperative Oncology Group score, Charlson's Comorbidity Index, number of functioning segments resected.The high-risk group consisted of 141 patients (age75 years: 84 patients; FEV150: 14 patients; DLCO50: 25 patients; history of CAD: 37 patients). The propensity score yielded two groups of 135 patients (high-risk vs low-risk) well matched for several baseline characteristics except for a lower performance status in the higher-risk group. Compared with their low-risk counterparts, high-risk patients had a higher incidence of cardiopulmonary complications (28 cases, 21% vs 14 cases, 10%; P0.0001) and major cardiopulmonary complications (12 cases, 9% vs 3 cases, 2%; P0.0001). Postoperative stay was 3 days longer in high-risk patients (8.6 vs 5.5 days, P = 0.0031). The 30-day or in-hospital mortality rates were not different between the two groups (2 cases, 1.5% vs 3 cases, 2.2%, P = 0.93).The incidence of major complications after VATS lobectomy in high-risk patients is low, but not negligible. This information can be used when discussing surgical risk with the patient during preoperative counselling. |
| Databáze: | OpenAIRE |
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