All grades of severity of postoperative adverse events are associated with prolonged length of stay after lung cancer resection

Zach Zhang; Fargol Mostofian; Jelena Ivanovic; Sebastien Gilbert; Donna E Maziak; Farid M Shamji; Sudhir Sundaresan; Patrick J Villeneuve; Andrew J E Seely

doi:10.1016/j.jtcvs.2017.09.094

All grades of severity of postoperative adverse events are associated with prolonged length of stay after lung cancer resection

J Thorac Cardiovasc Surg. 2018 Feb;155(2):798-807. doi: 10.1016/j.jtcvs.2017.09.094. Epub 2017 Sep 28.

Authors

Zach Zhang¹, Fargol Mostofian¹, Jelena Ivanovic², Sebastien Gilbert³, Donna E Maziak⁴, Farid M Shamji⁵, Sudhir Sundaresan³, Patrick J Villeneuve⁵, Andrew J E Seely⁶

Affiliations

¹ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
² School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁴ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁵ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁶ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address: [email protected].

PMID: 29103816
DOI: 10.1016/j.jtcvs.2017.09.094

Abstract

Objective: To determine whether all grades of severity of postoperative adverse events are associated with prolonged length of stay in patients undergoing pulmonary cancer resection.

Methods: This was a retrospective cohort study of all patients who underwent pulmonary resection with curative intent for malignancy at The Ottawa Hospital, Division of Thoracic Surgery (January 2008 to July 2015). Postoperative adverse events were collected prospectively with the Thoracic Morbidity & Mortality System, based on the Clavien-Dindo severity classification. Patient demographics, comorbidities, preoperative investigations, cardiopulmonary assessment, pathologic staging, operative characteristics, and length of stay were retrospectively reviewed. Prolonged hospital stay was defined as >75th percentile for each procedure performed (wedge resection 6 days, segmentectomy 6 days, lobectomy 7 days, extended lobectomy 8 days, pneumonectomy 10 days). Univariable and multivariable logistic regression analyses were conducted to identify factors associated with prolonged hospital stay.

Results: Of 1041 patients, 579 (55.6%) were female, 610 (58.1%) were >65 years old, 232 (22.3%) experienced prolonged hospital stay, and 416 (40.0%) patients had ≥1 postoperative adverse event. Multivariable analyses identified significant (P < .05) factors associated with prolonged hospital stay to be (odds ratio; 95% confidence interval): lower diffusion capacity of the lung for carbon monoxide (0.99; 0.98-0.99), surgical approach: open thoracotomy (1.8; 1.3-2.5), and presence of any postoperative adverse event: Grade I (5.8; 3.3-10.2), Grade II (6.0; 4.0-8.9), Grade III (11.4; 7.0-18.7), and Grade IV (19.40; 7.1-55.18).

Conclusions: Lower diffusion capacity of the lung for carbon monoxide, open thoracotomy approach, and the development of any postoperative adverse event, including minor events that required no additional therapy, were factors associated with prolonged hospital stay.

Keywords: lung cancer; perioperative risk factors; postoperative adverse events; prolonged length of stay; pulmonary resection.

Publication types

Video-Audio Media

MeSH terms

Aged
Female
Forced Expiratory Volume
Humans
Length of Stay*
Lung / physiopathology
Lung / surgery*
Lung Neoplasms / mortality
Lung Neoplasms / physiopathology
Lung Neoplasms / surgery*
Male
Middle Aged
Ontario
Pneumonectomy / adverse effects*
Pneumonectomy / mortality
Postoperative Complications / etiology*
Postoperative Complications / mortality
Postoperative Complications / physiopathology
Postoperative Complications / therapy
Pulmonary Diffusing Capacity
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Thoracotomy / adverse effects
Time Factors
Treatment Outcome