Retrospective Observational Study into the Early Causes of Death Following Surgery for NSCLC

Jeremy Smelt; Fionna Martin; May Al-Sahaf; Natalie Simon; Juliet King; Lukacs Veres; Andrea Bille; John Pilling; Tom Routledge; Karen Harrison-Phipps

doi:10.1055/s-0038-1676590

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2020; 68(07): 633-638
DOI: 10.1055/s-0038-1676590

Original Thoracic

Retrospective Observational Study into the Early Causes of Death Following Surgery for NSCLC

Jeremy Smelt

¹Department of Thoracic Surgery, Guy’s and Saint Thomas’ NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

,

Fionna Martin

²Department of Geriatric and Pops Medicine, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

,

May Al-Sahaf

¹Department of Thoracic Surgery, Guy’s and Saint Thomas’ NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

,

Natalie Simon

¹Department of Thoracic Surgery, Guy’s and Saint Thomas’ NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

,

Juliet King

¹Department of Thoracic Surgery, Guy’s and Saint Thomas’ NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

,

Lukacs Veres

¹Department of Thoracic Surgery, Guy’s and Saint Thomas’ NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

,

Andrea Bille

¹Department of Thoracic Surgery, Guy’s and Saint Thomas’ NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

,

John Pilling

¹Department of Thoracic Surgery, Guy’s and Saint Thomas’ NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

,

Tom Routledge

¹Department of Thoracic Surgery, Guy’s and Saint Thomas’ NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

,

Karen Harrison-Phipps

¹Department of Thoracic Surgery, Guy’s and Saint Thomas’ NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland

› Author Affiliations

Abstract

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Abstract

Introduction Respiratory failure has historically been the major cause of mortality after elective lung resections. With improved intubation using fiber-optic scopes, better preoperative respiratory risk assessment, more advanced anesthetic single lung ventilation, and minimally invasive surgical technique, this may have changed. Our objective was to assess the main causes of mortality over the past 10 years in patients undergoing elective lung surgery in a major UK center.

Materials and Methods A retrospective unit data search was made for all deaths during the 10-year period between January 2007 and December 2016 inclusive. All inpatient deaths within 30 days of an elective anatomical lung resection for lung malignancies were included.

Results Three-thousand three-hundred sixteen lung resections for malignancy were performed in the 10-year period. There were 44 (1.3%) deaths during this period, 27 (61.4%) after open lobectomies, 8 (18.2%) after video-assisted thoracoscopic surgery lobectomies, 5 (11.4%) after sleeve lobectomies, and 4 (9%) after pneumonectomies. Causes of death included 24 (54.5%) respiratory failure, 10 (22.7%) ischemic bowel, 4 (9%) coronary events, 2 (4.5%) strokes, 2 (4.5%) on table hemorrhage, 1 (2.3%) massive pulmonary embolus, and 1 (2.3%) postoperative hemorrhage.

Conclusion Although respiratory failure is still a major cause of mortality in the postoperative patient, bowel ischemia has been found to be the second greatest cause of death. This study highlights the need to identify those at risk of this fatal complication during preoperative assessment and their postoperative management.

Keywords

lung cancer - thoracic surgery - in-hospital mortality - mesenteric ischemia - atrial fibrillation

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References

References
1 Khuri SF, Daley J, Henderson W. et al. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997; 185 (04) 315-327
2 Kearney DJ, Lee TH, Reilly JJ, DeCamp MM, Sugarbaker DJ. Assessment of operative risk in patients undergoing lung resection. Importance of predicted pulmonary function. Chest 1994; 105 (03) 753-759
3 Puri V, Crabtree TD, Bell JM. et al. National cooperative group trials of “high-risk” patients with lung cancer: are they truly “high-risk”?. Ann Thorac Surg 2014; 97 (05) 1678-1683 , discussion 1683–1685
4 Aberle DR, Adams AM, Berg CD. et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365 (05) 395-409
5 Ahmed HZ, Liu Y, O'Connell K. et al. Guideline-concordant care improves overall survival for locally advanced non-small-cell lung carcinoma patients: a national cancer database analysis. Clin Lung Cancer 2017; 18 (06) 706-718
6 Coebergh JW. Epidemiology in Europe. Eur J Cancer 2001; 37 (Suppl. 07) S217-S227
7 Field JK, Duffy SW, Baldwin DR. et al. UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening. Thorax 2016; 71 (02) 161-170
8 Nakahara K, Ohno K, Hashimoto J. et al. Prediction of postoperative respiratory failure in patients undergoing lung resection for lung cancer. Ann Thorac Surg 1988; 46 (05) 549-552
9 Sengupta S. Post-operative pulmonary complications after thoracotomy. Indian J Anaesth 2015; 59 (09) 618-626
10 Sekine Y, Behnia M, Fujisawa T. Impact of COPD on pulmonary complications and on long-term survival of patients undergoing surgery for NSCLC. Lung Cancer 2002; 37 (01) 95-101
11 Beccaria M, Corsico A, Fulgoni P. et al. Lung cancer resection: the prediction of postsurgical outcomes should include long-term functional results. Chest 2001; 120 (01) 37-42
12 Licker MJ, Widikker I, Robert J. et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg 2006; 81 (05) 1830-1837
13 Lim E, Baldwin D, Beckles M. et al; British Thoracic Society, Society for Cardiothoracic Surgery in Great Britain and Ireland. Guidelines on the radical management of patients with lung cancer. Thorax 2010; 65 (Suppl. 03) iii1-iii27
14 Roxburgh JC, Thompson J, Goldstraw P. Hospital mortality and long-term survival after pulmonary resection in the elderly. Ann Thorac Surg 1991; 51 (05) 800-803
15 Ginsberg RJ, Hill LD, Eagan RT. et al. Modern thirty-day operative mortality for surgical resections in lung cancer. J Thorac Cardiovasc Surg 1983; 86 (05) 654-658
16 https://scts.org/outcomes/thoracic/">https://scts.org/outcomes/thoracic/ (accessed on 26/7/2017).
17 Falcoz PE, Conti M, Brouchet L. et al. The Thoracic Surgery Scoring System (Thoracoscore): risk model for in-hospital death in 15,183 patients requiring thoracic surgery. J Thorac Cardiovasc Surg 2007; 133 (02) 325-332
18 Varela G, Novoa NM, Agostini P, Ballesteros E. Chest physiotherapy in lung resection patients: state of the art. Semin Thorac Cardiovasc Surg 2011; 23 (04) 297-306
19 Dales RE, Dionne G, Leech JA, Lunau M, Schweitzer I. Preoperative prediction of pulmonary complications following thoracic surgery. Chest 1993; 104 (01) 155-159
20 Okada M, Nishio W, Sakamoto T. et al. Evolution of surgical outcomes for nonsmall cell lung cancer: time trends in 1465 consecutive patients undergoing complete resection. Ann Thorac Surg 2004; 77 (06) 1926-1930 , discussion 1931
21 Sancheti MS, Melvan JN, Medbery RL. et al. Outcomes after surgery in high-risk patients with early stage lung cancer. Ann Thorac Surg 2016; 101 (03) 1043-1050 , Discussion 1051
22 Al-Sahaf M, Lim E. The association between surgical volume, survival and quality of care. J Thorac Dis 2015; 7 (Suppl. 02) S152-S155
23 Knott-Craig CJ, Howell CE, Parsons BD, Paulsen SM, Brown BR, Elkins RC. Improved results in the management of surgical candidates with lung cancer. Ann Thorac Surg 1997; 63 (05) 1405-1409 , discussion 1409–1410
24 Clair DG, Beach JM. Mesenteric Ischemia. N Engl J Med 2016; 374 (10) 959-968
25 Lorusso R, Mariscalco G, Vizzardi E, Bonadei I, Renzulli A, Gelsomino S. Acute bowel ischemia after heart operations. Ann Thorac Surg 2014; 97 (06) 2219-2227
26 Hamilton-Davies C, Mythen MG, Salmon JB, Jacobson D, Shukla A, Webb AR. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry. Intensive Care Med 1997; 23 (03) 276-281
27 Dyszkiewicz W, Skrzypczak M. Atrial fibrillation after surgery of the lung: clinical analysis of risk factors. Eur J Cardiothorac Surg 1998; 13 (06) 625-628
28 Garner M, Routledge T, King JE. et al. New-onset atrial fibrillation after anatomic lung resection: predictive factors, treatment and follow-up in a UK thoracic centre. Interact Cardiovasc Thorac Surg 2017; 24 (02) 260-264
29 Polanczyk CA, Marcantonio E, Goldman L. et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 2001; 134 (08) 637-643
30 Partridge JS, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing 2012; 41 (02) 142-147
31 Liu LL, Leung JM. Predicting adverse postoperative outcomes in patients aged 80 years or older. J Am Geriatr Soc 2000; 48 (04) 405-412
32 Partridge JS, Dhesi JK, Cross JD. et al. The prevalence and impact of undiagnosed cognitive impairment in older vascular surgical patients. J Vasc Surg 2014; 60 (04) 1002-11.e3
33 Partridge JS, Fuller M, Harari D, Taylor PR, Martin FC, Dhesi JK. Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes. Int J Surg 2015; 18: 57-63
34 Partridge JS, Harari D, Martin FC. et al. Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg 2017; 104 (06) 679-687
35 Smelt J, A-Sahaf M, Martin F. et al. P-195 a study into the evolving causes of death in elective lung resections for malignancy. Interact Cardiovasc Thorac Surg 2017; 25: sp1