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 language | English (US) |
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Pages (from-to) | 206-215 |
Number of pages | 10 |
Journal | Journal of the American College of Surgeons |
Volume | 215 |
Issue number | 2 |
DOIs | |
State | Published - Aug 2012 |
Funding
Dr Bentrem is supported by a Career Development Award from the Health Services Research and Development Service of the Department of Veterans Affairs.
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