Effect of Socio-Economic Status on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

Anastasia Jermihov; Liwei Chen; Maria F Echavarria; Emily P Ng; Frank O Velez; Carla C Moodie; Joseph R Garrett; Jacques P Fontaine; Eric M Toloza

doi:10.7759/cureus.26201

Effect of Socio-Economic Status on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

Cureus. 2022 Jun 22;14(6):e26201. doi: 10.7759/cureus.26201. eCollection 2022 Jun.

Authors

Affiliations

¹ School of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA.
² Surgery, University of South Florida Health Morsani College of Medicine, Tampa, USA.
³ Thoracic Oncology, Moffitt Cancer Center, Tampa, USA.
⁴ Surgery and Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, USA.

Abstract

Background: Lower socioeconomic status (SES) has been correlated with poor survival rates and surgical outcomes following lung cancer resection. This study sought to determine whether this disparity exists perioperatively in lung cancer patients following robotic-assisted video-thoracoscopic pulmonary lobectomy. Methods: We retrospectively reviewed 447 consecutive patients who underwent robotic-assisted pulmonary lobectomy by one surgeon for known or suspected lung cancer. Ten patients were excluded due to incomplete data. We used median income by residential ZIP code as a surrogate for SES status and grouped patients based on whether ZIP-based median income was less than (Group 1) or greater than (Group 2) 300% of the federal poverty income level. The effects of SES status groups on incidence of postoperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality were evaluated by the logistic regression model and Inverse Gaussian regression model, respectively.

Results: Without adjustment, Group 1 tended to have a higher rate of postoperative complications, with 54% of patients experiencing complications compared to 34% of patients in Group 2 (p=0.007). Median chest tube duration and hospital LOS were also significantly longer in Group 1 than in Group 2 (p=0.034). In multivariable logistical regression analysis, while controlling for covariates and considering effect modifications, lower SES was significantly and positively associated with postoperative complications (odds ratio (OR)=1.98, p=0.039). Preoperative chronic obstructive pulmonary disease (COPD) was also a positive and significant predictor of postoperative complications (OR=1.89, p=0.017), chest tube duration (p=0.020), and LOS (p=0.010).

Conclusions: Lower median income is associated with a greater number of postoperative complications following pulmonary resection for lung cancer when controlling for covariates.

Keywords: minimally invasive surgery; perioperative outcomes; pulmonary lobectomy; robotic surgery; socio-economic status.

Grants and funding

This study was supported in part by the Health Professions Scholarship Program awarded to AJ from the United States Air Force, in part by support to AJ from the Scholarly Excellence, Leadership Experiences, and Collaborative Training (SELECT) Program of the USF Health Morsani College of Medicine and the Lehigh Valley Health Network, and in part by 2014 Summer Scholarly Awards to MFE and to EPN from the Scholarly Concentrations Program of the University of South Florida (USF) Health Morsani College of Medicine