Risk Factors and Impact of Conversion to Thoracotomy From 20,565 Cases of Thoracoscopic Lung Surgery

Abstract

Background: Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery is a major concern and can be associated with increased adverse outcomes. Therefore, this study was conducted to identify any possible clinical risk factors and related outcomes.

Methods: This monocentric retrospective study was conducted between January 2016 and December 2018 and included 20,565 consecutive patients who were undergoing thoracoscopic lung operations. Planned thoracotomy, complete pneumonectomies, angioplastic or bronchoplastic or chest wall resections, bilateral lung resections, or cases with missing data were excluded. Univariate and multivariate analyses were performed to identify risk factors for conversion to thoracotomy. A 1:1 propensity score matching analysis was conducted to verify postoperative outcomes.

Results: The overall incidence of conversion to thoracotomy was 1.0% (205 of 20,565). The most common cause of conversion was vascular injury, found in 60 patients (29.3%). Multivariable logistic regression analysis identified age older than 60 years, male sex, preoperative chemotherapy, lesion diameter of 1.4 cm or larger, clinical nodal involvement, lymph node calcification, pleural adhesions, type of resection, location of resection, ipsilateral reoperation, and lower surgical experience as independent risk factors of conversion. Among patients who underwent conversion to thoracotomy and who had any complications, the percentages of pulmonary complications, chest tube duration, intensive care unit stay, and hospital length of stay were higher. Within the conversion groups, emergency (37 of 205; 18%) and nonemergency (168 of 205; 82%) conversion groups were similar for overall postoperative complications.

Conclusions: The study identified 11 potential risk factors of conversion to thoracotomy, which was associated with increased postoperative complications. The findings may be important for operative planning, preoperative patient counseling and risk adjustment, and eventually reducing conversion rates and related outcomes.