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Trends in open lobectomy outcomes for lung cancer over the last 15 years: national cohort

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Abstract

Objective

Adoption of thoracoscopic lobectomy has been increasing in the US; however, open lobectomy (OL) is still performed in half of the cases. Postoperative care and enhanced recovery after surgery (ERAS) pathways have evolved and improved outcomes. The study aims to evaluate postoperative outcomes of OL over the last 15 years.

Methods

Patients who underwent lobectomy for lung cancer between 2005 and 2019 were identified in the National Surgical Quality Improvement Program and divided into three groups; pre-ERAS (2005–2011), transitional period (2012–2015), and wider ERAS implementation (2016–2019). Preoperative characteristics and postoperative outcomes were compared and multivariable regression analysis was constructed to assess independent predictors of outcomes.

Results

OL was comprised of 40% of lobectomies for lung cancer. 10,021 patients met inclusion criteria. 49% were males and mean age was 67. Patients who belonged to the (2016–2019) period group had significantly higher comorbidities and ASA classification. General surgeons performed < 10% of OL in 2016–2019 compared to over 30% during 2005–2011. Patients in the 2016–2019 period were less likely to experience unplanned intubation, surgical site infections, and sepsis. Mortality was also significantly lower than the previous groups (1.9% vs 2.0% and 2.8%, p = 0.05). The rate of discharge to facility as well as length of hospital stays improved over the years. The surgeon specialty served as an independent predictor for length of stay, unplanned intubation, and home discharge.

Conclusion

The outcomes of OL are improving over the years. Increasing number of these surgeries being performed by dedicated thoracic surgeons and ERAS pathways are likely helping improve outcomes.

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Authors and Affiliations

  1. Department of Surgery, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23298, USA

    Yahya Alwatari, Daniel Scheese, Salem Rustom, Athanasios E. Sevdalis, Dawit Ayalew, Walker Julliard & Rachit D. Shah

Authors
  1. Yahya Alwatari
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  2. Daniel Scheese
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  3. Salem Rustom
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  4. Athanasios E. Sevdalis
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  5. Dawit Ayalew
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  6. Walker Julliard
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  7. Rachit D. Shah
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Contributions

Drs. Alwatari, Scheese, Sevdalis, Ayalew, Julliard, and Shah, and Mr. Rustom were responsible for study design, and data acquisition. Mr. Rustom and Dr. Alwatari completed the analysis. All the authors contributed to drafting the manuscript, revising it critically, and provided approval of the final manuscript version.

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Correspondence to Yahya Alwatari.

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Alwatari, Y., Scheese, D., Rustom, S. et al. Trends in open lobectomy outcomes for lung cancer over the last 15 years: national cohort. Gen Thorac Cardiovasc Surg 70, 144–152 (2022). https://doi.org/10.1007/s11748-021-01703-4

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  • DOI: https://doi.org/10.1007/s11748-021-01703-4

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