In-hospital Complications Of Thoracic Cancer Lobectomies: Does Tumor Location Matter?
Iftekhar Kalsekar, Sudip Ghosh, Edmund Kassis, Andrew Yoo.
Johnson & Johnson, New Brunswick, NJ, USA.
Objective: Identification of risk factors for complications in patients undergoing thoracic lobectomies for cancer may assist with procedural risk adjustment. This study assesses whether lobe anatomy affects in-hospital complications.
Methods: The study used the Premier Perspective® Database, containing billing data from over 600 U.S. hospitals. Procedures and diagnoses were identified by ICD-9 codes. All elective lobectomies with a primary diagnosis of upper, middle, or lower lobe lung cancer from 2012-2014 were identified. Complications were identified with diagnosis codes: any Air Leak Complications (aALC)-a combination of air leak and pneumothorax, infection and bleeding composites. Patient, procedure, and hospital factors were included in multivariable logistic regression models to assess the impact of lobe anatomy on complications. Analysis was stratified by approach and accounted for hospital clustering.
Results: A total of 8,750 thoracic lobectomies for lung cancer were identified: upper lobe (n=5,284), middle lobe (n=512), and lower lobe (n=2,954). A slightly higher fraction of surgical approaches were traditional thoracotomy (54.2%;n=4,746) compared to Video Assisted Thoracoscopic Surgery (VATS) (45.8%;n=4,004). The incidence of aALC was 28.3% (Air leak=16.4% and pneumothorax=14.8%). The incidence of bleeding and infections was 11.3% and 8.2% respectively. Results of the multivariable analysis [Table 1] showed that for VATS, lobe anatomy had a significant effect on complications. The odds of having an aALC were 27% lower for lower lobe and 61% lower for middle lobe compared to upper lobe. Compared to upper lobe, lower lobe had a 25% reduction in odds of bleeding and middle lobe had a 67% reduction in odds of infection. For thoracotomy, only lower lobe had significant reductions in the odds of aALC; a 12% reduction which was driven by a 23% reduction in air leaks compared to upper lobe.
Conclusion: This analysis shows that the effect of lobe anatomy is modified by surgical approach. In VATS lobectomy for cancer, upper lobe had increased odds of air leak complications, bleeding, and infection compared to those in the middle and lower lobes.
|Table 1||VATS Lobectomy||Thoracotomy Lobectomy|
|(ref = Upper Lobe)||(ref = Upper Lobe)|
|Odds Ratio (95% CI)||Odds Ratio (95% CI)|
|Lower Lobe||Middle Lobe||Lower Lobe||Middle Lobe|
|any Air Leak Complications (aALC)||0.73 (0.62–0.86)*||0.39 (0.26–0.58)*||0.88 (0.78–0.99)*||0.80 (0.58–1.11)|
|Air Leaks||0.76 (0.61–0.95)*||0.35 (0.19–0.63)*||0.77 (0.65–0.90)*||0.78 (0.52–1.17)|
|Pneumothorax||0.73 (0.60–0.89)*||0.45 (0.28–0.72)*||1.06 (0.92–1.23)||0.72 (0.47–1.10)|
|Bleeding (composite)||0.75 (0.61–0.92)*||0.75 (0.43–1.29)||0.91 (0.75–1.11)||0.84 (0.57–1.24)|
|Infections (composite)||1.03 (0.78–1.35)||0.33 (0.14–0.82)*||0.92 (0.75–1.13)||0.79 (0.51–1.20)|
Back to 2017 Posters