Factors affecting selection of operative approach and subsequent short-term outcomes after anatomic resection for lung cancer

Joseph D. Phillips, Ryan P. Merkow, Karen L. Sherman, Malcolm M. DeCamp, David J. Bentrem, Karl Y. Bilimoria*

*Corresponding author for this work

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Background: Previous studies evaluating video-assisted thoracoscopic surgery (VATS) for lung cancer are single-institution series, suffer from small sample size, or use administrative or self-reported databases. Using a multi-institutional, standardized, and audited surgical outcomes database, our objectives were to examine preoperative factors associated with undergoing VATS vs open resection and assess subsequent perioperative outcomes. Study Design: The American College of Surgeons National Surgical Quality Improvement Program Participant Use File was used to identify patients who underwent anatomic resection (eg, segmentectomy, lobectomy, and bi-lobectomy) for primary lung cancer (2005 to 2010). Multiple logistic regression models, including propensity scores, were developed to assess preoperative factors associated with undergoing VATS and the risk-adjusted association between operative approach and 30-day outcomes. Results: Of 2,353 patients undergoing resection, 74% underwent open thoracotomy (OT) and 26% underwent VATS. After regression for confounders, factors associated with undergoing a VATS were patient age older than 75 years (odds ratio [OR] = 1.41; 95% CI, 1.05-1.90), Hispanic ethnicity (OR = 2.52; 95% CI, 1.69-3.77), and cardiothoracic surgery training (OR = 1.68; 95% CI, 1.37-2.07). Patients undergoing OT had a higher likelihood of any adverse event developing (24% vs 14%; OR = 1.76; 95% CI, 1.35-2.29), specifically pneumonia and sepsis/septic shock. Median length of stay was significantly longer in the OT group (7 vs 4 days; p < 0.001). Mortality was not significantly different for VATS vs OT after regression for confounders. Conclusions: In addition to patient factors, surgeon training can play a role in determining the operative approach offered to patients. Patients selected for VATS had a lower 30-day morbidity and shorter length of stay compared with OT anatomic resection for primary lung cancer.

Original languageEnglish (US)
Pages (from-to)206-215
Number of pages10
JournalJournal of the American College of Surgeons
Volume215
Issue number2
DOIs
StatePublished - Aug 1 2012

Keywords

  • ACS NSQIP
  • ASA
  • American College of Surgeons National Surgical Quality Improvement Program
  • American Society of Anesthesiologists
  • CPT
  • Current Procedural Terminology
  • LOS
  • OR
  • OT
  • VATS
  • length of stay
  • odds ratio
  • open thoracotomy
  • video-assisted thoracoscopic surgery

ASJC Scopus subject areas

  • Surgery

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