Mortality Predictors In Complicated Patients After Anatomical Lung Resection

M A Teresa Gómez Hernández; Nuria Novoa Valentín; Marta Fuentes Gago; José Luis Aranda Alcaide; Gonzalo Varela Simó; Marcelo F Jiménez López

doi:10.1016/j.arbres.2020.04.015

Mortality Predictors In Complicated Patients After Anatomical Lung Resection

Arch Bronconeumol (Engl Ed). 2020 May 31:S0300-2896(20)30132-0. doi: 10.1016/j.arbres.2020.04.015. Online ahead of print.

[Article in English, Spanish]

Authors

M A Teresa Gómez Hernández¹, Nuria Novoa Valentín², Marta Fuentes Gago², José Luis Aranda Alcaide², Gonzalo Varela Simó³, Marcelo F Jiménez López²

Affiliations

¹ Departamento de Cirugía Torácica. Hospital Universitario de Salamanca, Salamanca, España. Electronic address: mteresa.gomez.hernandez@gmail.com.
² Departamento de Cirugía Torácica. Hospital Universitario de Salamanca, Salamanca, España.
³ Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.

PMID: 32493640
DOI: 10.1016/j.arbres.2020.04.015

Abstract

Introduction: Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections.

Method: Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model.

Results: A total of 2,569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77-0.88).

Conclusions: Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.

Keywords: Fallo en el rescate; Mortalidad postoperatoria; Postoperative mortality; Pulmonary resection; Rescue failure; Resección pulmonar; Riesgo quirúrgico; Surgical risk.