Analyzing Risk Factors for Morbidity and Mortality after Lung Resection for Lung Cancer Using the NSQIP Database

Jean, Raymond; DeLuzio, Matthew R.; Kraev, Alexander I.; Wang, Gongyi; Boffa, Daniel J.; Detterbeck, Frank C.; Wang, Zuoheng; Kim, Anthony W.

doi:10.1016/j.jamcollsurg.2016.02.020

Cited by 38 publications

(31 citation statements)

References 21 publications

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“…Studies have investigated the role of preoperative anemia in the general surgery population and in specialized patient populations such as orthopedic, spinal, lung, hepatic, colorectal, and head and neck surgery; however, literature on the impact of anemia on surgical outcomes in splenectomy patients is lacking [ [9] , [10] , [11] , [12] , [13] , [14] , [15] ]. Anemia is a common clinical feature noted preoperatively in patients requiring splenectomy secondary to traumatic, hematologic, and oncologic etiologies [ [16] , [17] , [18] ].…”

Section: Introductionmentioning

confidence: 99%

Is preoperative anemia a significant risk factor for splenectomy patients? A NSQIP analysis

Agathis

Khetan

Bitner

et al. 2020

Surgery Open Science

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Background Prior literature has examined the association between preoperative anemia and complications across surgical settings; however, evidence is lacking for splenectomy patients. We investigated the association between preoperative hematocrit and 30-day postoperative outcomes in this population using a national database. Methods Patients who underwent splenectomy (2012–2017) were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Analyses were performed for the overall cohort and elective versus emergent subsets, adjusting for transfusion among other covariates. Results Our sample included 5,580 patients. As hematocrit decreased, complication rates increased incrementally in both the univariate and multivariate analyses. Adjusted odds ratios (and 95% confidence intervals) for moderate anemia (26% ≤ hematocrit < 30%) as compared to no anemia (hematocrit ≥ 38%) were readmission = 1.5 (1.1–1.8), sepsis = 2.2 (1.6–3.0), and composite outcome = 1.8 (1.0–3.2). Parameter estimates (standard error, P value) for the moderate versus no anemia group were length of stay = 3.0 (0.5, P < .001) and days to discharge = 1.2 (0.3; P < .001). Conclusion Our results demonstrate a dose-response relationship between increasing degree of anemia and odds of various postoperative adverse outcomes after adjusting for several potential confounders. The subset analysis further suggests that elective splenectomy cases are more likely to have poor outcomes when in the presence of anemia or when transfusions are performed as compared to emergent cases. This suggests that the harm associated with transfusion may offset the benefit of optimizing anemia in an elective splenectomy case.

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Section: Introductionmentioning

confidence: 99%

Is preoperative anemia a significant risk factor for splenectomy patients? A NSQIP analysis

Agathis

Khetan

Bitner

et al. 2020

Surgery Open Science

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“…Factors that have been associated with worse perioperative outcomes following lobectomy include increasing age, male sex, smoking history, comorbidities (including COPD and prior cardiovascular event), degree of dyspnea, type of operation (thoracotomy versus thoracoscopy), rightsided tumors, decreased facility surgical volume, anemia, dysnatremia, and functional status (6)(7)(8)(9)(10) as assessed by spirometry, exercise testing to determine peak VO 2 , performance status, and evaluation of physical reserve (11). Frailty, defined as a lack of physiologic reserve resulting in adverse outcomes, has also been recognized as an independent risk factor for inferior outcome in regard to mortality and morbidity in the elderly, those undergoing surgery, and cancer patients (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia is a predictor of outcomes after lobectomy

et al. 2018

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Background: As screening for lung cancer rises, an increase in the diagnosis of early stage lung cancers is expected. Lobectomy remains the standard treatment, but there are alternatives, consideration of which requires an estimation of the risk of surgery. Sarcopenia, irrespective of body mass index, confers a worse prognosis in many groups of patients including those undergoing surgery. Here we examine the association of muscle mass with outcomes for patients undergoing lobectomy. Methods: Consecutive patients undergoing lobectomy were retrospectively reviewed. Preoperative computed tomography scans were reviewed, and cross-sectional area of the erector spinae muscles and pectoralis muscles was determined and normalized for height. Univariate and multivariate analyses were then done to examine for an association of muscle mass with morbidity and short-and long-term mortality. Results: During the study period, there were 299 lobectomies, 278 of which were done by video assisted thoracoscopic surgery. The average age of the patients was 67.5±10.6 years. Overall complication rate was 52.2%, pneumonia rate was 8.7%, and the 30-day mortality rate was 1.3%. Mean height adjusted-erector spinae muscle cross-sectional area was 10.6±2.6 cm 2 /m 2 , and mean height adjusted-pectoralis muscle cross sectional area was 13.3±3.8 cm 2 /m 2 . The height adjusted cross sectional areas of the erector spinae and pectoralis muscles were not associated with overall complication rate, rate of pneumonia, readmission, or intensive care unit length of stay. The height adjusted-erector spinae muscle cross sectional area was inversely correlated with 30-day mortality risk, odds ratio 0.77 (95% CI, 0.60-0.98, P=0.036). Mean length of stay was 7.0 days (95% CI, 5.5-8.4 days). Multivariate analysis demonstrated a significant inverse association of the height adjusted-erector spinae muscle cross sectional area with length of stay (P=0.019). Conclusions:The height adjusted-erector spinae muscle cross sectional area was significantly associated with 30-day mortality and length of stay in the hospital. Measurement of muscle mass on preoperative computed tomography imaging may have a role to help predict risk of morbidity and mortality prior to lobectomy.

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“…Therefore, we recommend using quantitative scores for patient individual operative risk assessment and considering these in the process of patient selection. [14][15][16] Beyond patient characteristics influencing the operative risk, surgical experience is a documented factor affecting overall survival after pulmonary surgery and specialized centers have reported a surgical mortality after lobectomy less than 1% after minimally invasive resection by video-assisted thoracic surgery or robotic-assisted resection. 17 However, systematic studies analyzing the effect of surgical volume and expertise on perioperative mortality showed only mixed results regarding perioperative mortality risk in high-volume centers.…”

Section: Bryan M Burt Mdmentioning

confidence: 99%

The American Society of Clinical Oncology–endorsed American Society for Radiation Oncology Evidence-Based Guideline of stereotactic body radiotherapy for early-stage non–small cell lung cancer: An expert opinion

Gückenberger

Aerts

Schil

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Feature Editor's Note-After reading this Feature Expert Opinion, it should be more evident than ever that lobectomy is the current standard of care for patients with stage I non-small cell lung cancer (NSCLC) who are medically fit for operation. It is common, however, for fit patients with stage I NSCLC to perceive stereotactic body radiotherapy (SBRT) as an attractive option for the treatment of their disease. SBRT is a noninvasive, well-tolerated outpatient procedure, and the Internet is replete with favorable efficacy statistics for SBRT that cannot be appropriately interpreted without a certain background in the field. As is common with all new and exciting technologies, innovation is provided with an opportunity to outpace the standard of care. SBRT for NSCLC is a relatively young and rapidly evolving modality of radiotherapy that has shown favorable results for control of the localized tumor mass in patients with stage I lung cancer who are not candidates for surgery. Consideration of SBRT to treat patients with stage I NSCLC who are medically fit for operation has resulted in the launching of 3 randomized controlled clinical trials (ROSEL, STARS, ACOSOG Z4099) comparing lobectomy with SBRT for operable stage I NSCLC, each of which closed prematurely because of poor accrual. In the absence of randomized data, 2 bodies of lower-level evidence literature on the comparative efficacies of surgery and SBRT for stage I lung cancer have emerged, one from the surgical community and one from the radiation oncology community. Sampling articles from each side of the aisle is an educational exercise that will benefit the reader's understanding of the disparities in outcomes reporting between each discipline and their implications for interpretation of results. Recently, the American Society for Radiation Oncology (ASTRO) published a refreshing evidence-based guideline on the role of SBRT in early stage NSCLC that was endorsed by the American Society of Clinical Oncology (ASCO). According to these guidelines, SBRT is not recommended as an alternative to surgery for patients with stage I NSCLC and standard operative risk, outside the context of a clinical trial. The Feature Expert Opinion article that follows is an interdisciplinary collaboration of surgery, radiation oncology, and pulmonology that will prime the readers on the most salient aspects of the ASTRO and ASCO guidelines for SBRT and offers a practical perspective for implementing these guidelines into practice. Bryan M. Burt, MDWe have witnessed controversies within the thoracic oncology community about the optimal treatment of early-stage non-small cell lung cancer (NSCLC), for which surgical lobectomy is challenged by stereotactic body radiotherapy (SBRT), and in the absence of randomized controlled trials, thoracic surgeons and radiation oncologists interpreted the available data in different ways. Therefore, the American Society for Radiation Oncology generated an evidence-based guideline on the role of SBRT in early-stage NSCLC: This guideline was From the

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Analyzing Risk Factors for Morbidity and Mortality after Lung Resection for Lung Cancer Using the NSQIP Database

Cited by 38 publications

References 21 publications

Is preoperative anemia a significant risk factor for splenectomy patients? A NSQIP analysis

Is preoperative anemia a significant risk factor for splenectomy patients? A NSQIP analysis

Sarcopenia is a predictor of outcomes after lobectomy

The American Society of Clinical Oncology–endorsed American Society for Radiation Oncology Evidence-Based Guideline of stereotactic body radiotherapy for early-stage non–small cell lung cancer: An expert opinion

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