Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Anthony W. Kim

Subject Area(s)

Surgery

Abstract

Abstract

THE IMPACT OF COMPLICATION TYPE ON MORTALITY IN PULMONARY LOBECTOMIES FOR PRIMARY LUNG CANCER. Timothy D. Law, Anthony W. Kim. Section of Thoracic Surgery, Department of Surgery, Yale University, School of Medicine, New Haven, CT.

Specific Aims: This study examines the impact of postoperative complications by type on perioperative mortality among lobectomies performed by thoracoscopic (VATS) and open thoracotomy (OPEN) approaches for primary lung cancer.

Methods: A retrospective analysis of the Healthcare and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database from 2007-2010 was performed. Patients with primary lung malignancies undergoing pulmonary lobectomy were selected, and perioperative complications within a 30 day period were identified. Multivariate statistical analysis was performed using Poisson and logistic regression modeling.

Results: 24,253 patients were included in the analysis, with 5,223 in the VATS cohort and 19,030 in the OPEN cohort. Number of complications was associated with mortality in both cohorts. The probability of mortality was higher in the OPEN cohort with either zero or one complication, but this disparity was lost as the number of complications increased. When categorized by complication type, pulmonary, cardiovascular, wound-related, systemic, and gastrointestinal complications were associated with mortality in both groups. Cardiovascular (OR 2.19, p=0.001) and wound-related (OR 1.77, p=0.041) complications were more strongly associated with mortality in the VATS cohort.

Conclusion: When cardiovascular complications occur following VATS lobectomy, their impact appears to be more significant than in OPEN lobectomies.

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