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Eur J Cardiothorac Surg. 2017 Jan;51(1):169-174. doi: 10.1093/ejcts/ezw239. Epub 2016 Jul 25.

The differential impact of preoperative comorbidity on perioperative outcomes following thoracoscopic and open lobectomies.

Author information

1
Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
2
Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
3
Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
4
Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA anthony.kim@yale.edu.

Abstract

OBJECTIVES:

Video-assisted thoracoscopic surgery (VATS) lobectomy is quickly becoming the standard of care for many patients with early-stage non-small-cell lung cancer (NSCLC) and benign lung conditions. There is a lack of published data defining the differential impact of preoperative patient comorbidity on outcomes following VATS and OPEN lobectomies, which would be beneficial for procedure selection and clinical decision-making.

METHODS:

A retrospective analysis of the 2008-2011 Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP) database was performed. Demographic and clinical data on patients ≥18 years having undergone VATS or OPEN lobectomy were included. Measured outcomes included postoperative length of stay (PO-LOS), in-hospital mortality and perioperative pulmonary complications. PO-LOS was further analysed using multivariable logistic regression and cumulative incidence models.

RESULTS:

VATS lobectomies were associated with shorter PO-LOS and fewer complications even after censoring for inpatient mortality. Furthermore, VATS lobectomy patients had improved PO-LOS compared with OPEN lobectomy patients, even with greater comorbidity. Logistic regression modelling for PO-LOS ≥14 days identified independent predictors of prolonged PO-LOS, including male gender, non-elective admission, lower hospital lobectomy volume, several Elixhauser comorbidities and performance of OPEN lobectomy.

CONCLUSIONS:

The expected postoperative length of stay for a patient treated by OPEN lobectomy is approximately equal to that of a VATS lobectomy patient with an additional 2-3 comorbidities. The VATS approach remains advantageous with respect to PO-LOS, regardless of the number of comorbidities.

KEYWORDS:

Lobectomy; Thoracoscopic; VATS

PMID:
27458143
DOI:
10.1093/ejcts/ezw239
[Indexed for MEDLINE]

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