Independent Predictors for Early and Midterm Mortality after Thoracic Surgery

Abstract

Background: The purpose of the present study was to determine independent predictors for early and midterm mortality for the whole context of thoracic surgery. Methods: We studied 1453 consecutive patients who underwent thoracic surgery between 2002 and 2005. Operations included lung resections (n = 504), mediastinal (n = 468), pleural and pericardial (n = 226), esophageal (n = 83), chest wall (n = 85), tracheal (n = 50) and other procedures (n = 37). Midterm survival data (mean follow-up 2.0 ± 1.1 years) were obtained from the National Death Index. Multivariate logistic regression was used to assess in-hospital mortality. Independent predictors for midterm mortality were determined by multivariate Cox regression analysis. Results: There were 47 (3.2 %) in-hospital and 312 (21.5 %) late deaths. Independent predictors for in-hospital mortality included Zubrod score (OR 2.72, p < 0.001), ASA score (OR 3.42, p < 0.001), pneumonectomy (OR 20.71, p = 0.001) and no history of cerebrovascular events (OR 0.27, p = 0.011). Independent predictors for midterm mortality included age (HR 1.03, p < 0.001), weight loss (HR 1.57, p = 0.005), Zubrod score (HR 1.47, p < 0.001), primary lung cancer (HR 1.98 p < 0.001), intrathoracic extrapulmonary metastases (HR 2.78, p < 0.001), primary chest wall tumor (HR 0.14, p = 0.008), diabetes requiring insulin (HR 1.71, p = 0.017), no preoperative renal failure (HR 0.57, p = 0.004), no comorbidities (HR 0.54, p = 0.009), ASA score (HR 1.69, p < 0.001), postoperative radiation treatment (HR 1.90, p = 0.016), pneumonectomy (HR 2.18, p = 0.040), reoperation for bleeding and/or postoperative transfusion (HR 3.10, p = 0.027) and postoperative pulmonary complications (HR 1.89, p = 0.013). Conclusions: We determined independent predictors for in-hospital and midterm mortality for the whole context of thoracic surgery. Zubrod and ASA scores affect both early and midterm mortality.

Key words

thoracic surgery - independent predictors - in‐hospital mortality - midterm mortality

References

• 1 Fowkes F G, Lunn J N, Farrow S C, Robertson I B, Samuel P. Epidemiology in anaesthesia. III: Mortality risk in patients with coexisting physical disease.  Br J Anaesth. 1982;  54 819-825
• 2 Prause G, Offner A, Ratzenhofer-Komenda B, Vicenzi M, Smolle J, Smolle-Juttner F. Comparison of two preoperative indices to predict perioperative mortality in non-cardiac thoracic surgery.  Eur J Cardiothorac Surg. 1997;  11 670-675
• 3 Clark R E. The development of The Society of Thoracic Surgeons voluntary national database system: genesis, issues, growth, and status.  Best Pract Benchmarking Healthc. 1996;  1 62-69
• 4 Williams B C, Demitrack L B, Fries B E. The accuracy of the National Death Index when personal identifiers other than social security number are used.  Am J Public Health. 1992;  82 1145-1147
• 5 Kaplan E L, Meier P. Nonparametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 547-581
• 6 Cox D R. Regression models and life-tables.  J R Stat Soc. 1972;  34 187-220
• 7 Hanley J A, McNeil B J. The meaning and use of the area under a receiver operating characteristic (ROC) curve.  Radiology. 1982;  143 29-36
• 8 Hosmer D W, Taber S, Lemeshow S. The importance of assessing the fit of logistic regression models: a case study.  Am J Public Health. 1991;  81 1630-1635
• 9 Detsky A S, Abrams H B, McLaughlin J R. et al . Predicting cardiac complications in patients undergoing non-cardiac surgery.  J Gen Intern Med. 1986;  1 211-219
• 10 Jeffrey C C, Kunsman J, Cullen D J, Brewster D C. A prospective evaluation of cardiac risk index.  Anesthesiology. 1983;  58 462-464
• 11 Zeldin R A. Assessing cardiac risk in patients who undergo noncardiac surgical procedures.  Can J Surg. 1984;  27 402-404
• 12 Lauven P M, Stoeckel H, Ebeling B J. Perioperative morbidity and mortality of geriatric patients. A retrospective study of 3905 cases.  Anasth Intensivther Notfallmed. 1990;  25 (Suppl 1) 3-9
• 13 Marx G F, Mateo C V, Orkin L R. Computer analysis of postanesthetic deaths.  Anesthesiology. 1973;  39 54-58
• 14 Pedersen T, Eliasen K, Ravnborg M. et al . Risk factors, complications and outcome in anaesthesia. A pilot study.  Eur J Anaesthesiol. 1986;  3 225-239
• 15 Vacanti C J, VanHouten R J, Hill R C. A statistical analysis of the relationship of physical status to postoperative mortality in 68,388 cases.  Anesth Analg. 1970;  49 564-566
• 16 Harpole Jr D H, DeCamp Jr M M, Daley J. et al . Prognostic models of thirty-day mortality and morbidity after major pulmonary resection.  J Thorac Cardiovasc Surg. 1999;  117 969-979
• 17 Krowka M J, Pairolero P C, Trastek V F, Payne W S, Bernatz P E. Cardiac dysrhythmia following pneumonectomy. Clinical correlates and prognostic significance.  Chest. 1987;  91 490-495
• 18 Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution.  Eur J Cancer. 1996;  32A 1135-1141
• 19 Roila F, Lupattelli M, Sassi M. et al . Intra and interobserver variability in cancer patients' performance status assessed according to Karnofsky and ECOG scales.  Ann Oncol. 1991;  2 437-439
• 20 Sorensen J B, Klee M, Palshof T, Hansen H H. Performance status assessment in cancer patients. An inter-observer variability study.  Br J Cancer. 1993;  67 773-775
• 21 De Valliere S, Barker R D. Poor performance status is associated with early death in patients with pulmonary tuberculosis.  Trans R Soc Trop Med Hyg. 2006;  100 681-686
• 22 Ferguson M K, Durkin A E. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer.  J Thorac Cardiovasc Surg. 2002;  123 661-669
• 23 Cavanaugh D G, Cabellon Jr S, Peake J B. A logical approach to chest wall neoplasms.  Ann Thorac Surg. 1986;  41 436-437
• 24 Pairolero P C, Arnold P G. Chest wall tumors. Experience with 100 consecutive patients.  J Thorac Cardiovasc Surg. 1985;  90 367-372
• 25 King R M, Pairolero P C, Trastek V F, Piehler J M, Payne W S, Bernatz P E. Primary chest wall tumors: factors affecting survival.  Ann Thorac Surg. 1986;  41 597-601
• 26 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 95-101
• 27 Toumpoulis I K, Anagnostopoulos C E, Ashton R C, Connery C P, DeRose J J, Swistel D G. Risk factors for respiratory failure and long-term survival following coronary artery bypass grafting.  Chest. 2004;  126 (Suppl) 855S-856S
• 28 Jagoditsch M, Pozgainer P, Klingler A, Tschmelitsch J. Impact of blood transfusions on recurrence and survival after rectal cancer surgery.  Dis Colon Rectum. 2006;  49 1116-1130