What counts more: The patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry

the Italian VATS group members

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons' ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3-6). Grade 1 and 2 and Grade 3-5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (<100 cases, P < 0.001), but there was no significant difference between intermediate- and high-volume centres under this aspect. Low-volume centres were significantly more likely to convert due to issues with difficult local anatomy, but not significantly so for bleeding. Conversion, lower case-volume, comorbidity burden, male gender, adhesions, blood loss, operative time, sealants and epidural analgesia were significantly associated with increased postoperative morbidity. CONCLUSIONS: VATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

Original languageEnglish
Pages (from-to)1097-1103
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume56
Issue number6
DOIs
Publication statusPublished - Dec 1 2019

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Video-Assisted Thoracic Surgery
Statistical Factor Analysis
Registries
Lung
Epidural Analgesia
Postoperative Care
Operative Time
Causality
Comorbidity
Anatomy
Thorax
Hemorrhage
Morbidity
Equipment and Supplies
Mortality
Neoplasms

Keywords

  • Conversion
  • Morbidity
  • Postoperative complications
  • Video-assisted thoracoscopic surgery lobectomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{a0bc68d04ab94fda888e0bb0a9e278ff,
title = "What counts more: The patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry",
abstract = "OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons' ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3-6). Grade 1 and 2 and Grade 3-5 complications were observed in 20.1{\%} and in 5.8{\%}, respectively. Ninety-day mortality was 0.55{\%}. The overall conversion rate was 9.2{\%} and significantly higher in low-volume centres (<100 cases, P < 0.001), but there was no significant difference between intermediate- and high-volume centres under this aspect. Low-volume centres were significantly more likely to convert due to issues with difficult local anatomy, but not significantly so for bleeding. Conversion, lower case-volume, comorbidity burden, male gender, adhesions, blood loss, operative time, sealants and epidural analgesia were significantly associated with increased postoperative morbidity. CONCLUSIONS: VATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.",
keywords = "Conversion, Morbidity, Postoperative complications, Video-assisted thoracoscopic surgery lobectomy",
author = "{the Italian VATS group members} and Infante, {Maurizio V.} and Cristiano Benato and Ronaldo Silva and Gaetano Rocco and Alessandro Bertani and Luca Bertolaccini and Alessandro Gonfiotti and Riccardo Giovannetti and Cinzia Bonadiman and Alessandro Lonardoni and Barbara Canneto and Giovanni Falezza and Paola Gandini and Carlo Curcio and Roberto Crisci and Francesco Zaraca and Marco Alloisio and Dario Amore and Luca Ampollini and Claudio Andreetti and Desideria Argnani and Guido Baietto and Alessandro Bandiera and Benvenuti, {Mauro Roberto} and Luigi Bortolotti and Edoardo Bottoni and Cristiano Breda and Pierpaolo Camplese and Paolo Carbognani and Giuseppe Cardillo and Caterina Casadio and Giorgio Cavallesco and Roberto Cherchi and Andrea Dell'Amore and Beffa, {Vittorio Della} and Giampiero Dolci and Andrea Droghetti and Ferrari, {Paolo A.} and Diego Fontana and Gaetano Gargiulo and Roberto Gasparri and Stefano Margaritora and Elisa Meacci and Giampiero Negri and Mario Nosotti and Lorenzo Rosso and Emanuele Russo and Lorenzo Spaggiari and Alessandro Stefani and Piergiorgio Solli",
year = "2019",
month = "12",
day = "1",
doi = "10.1093/ejcts/ezz187",
language = "English",
volume = "56",
pages = "1097--1103",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "6",

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TY - JOUR

T1 - What counts more

T2 - The patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry

AU - the Italian VATS group members

AU - Infante, Maurizio V.

AU - Benato, Cristiano

AU - Silva, Ronaldo

AU - Rocco, Gaetano

AU - Bertani, Alessandro

AU - Bertolaccini, Luca

AU - Gonfiotti, Alessandro

AU - Giovannetti, Riccardo

AU - Bonadiman, Cinzia

AU - Lonardoni, Alessandro

AU - Canneto, Barbara

AU - Falezza, Giovanni

AU - Gandini, Paola

AU - Curcio, Carlo

AU - Crisci, Roberto

AU - Zaraca, Francesco

AU - Alloisio, Marco

AU - Amore, Dario

AU - Ampollini, Luca

AU - Andreetti, Claudio

AU - Argnani, Desideria

AU - Baietto, Guido

AU - Bandiera, Alessandro

AU - Benvenuti, Mauro Roberto

AU - Bortolotti, Luigi

AU - Bottoni, Edoardo

AU - Breda, Cristiano

AU - Camplese, Pierpaolo

AU - Carbognani, Paolo

AU - Cardillo, Giuseppe

AU - Casadio, Caterina

AU - Cavallesco, Giorgio

AU - Cherchi, Roberto

AU - Dell'Amore, Andrea

AU - Beffa, Vittorio Della

AU - Dolci, Giampiero

AU - Droghetti, Andrea

AU - Ferrari, Paolo A.

AU - Fontana, Diego

AU - Gargiulo, Gaetano

AU - Gasparri, Roberto

AU - Margaritora, Stefano

AU - Meacci, Elisa

AU - Negri, Giampiero

AU - Nosotti, Mario

AU - Rosso, Lorenzo

AU - Russo, Emanuele

AU - Spaggiari, Lorenzo

AU - Stefani, Alessandro

AU - Solli, Piergiorgio

PY - 2019/12/1

Y1 - 2019/12/1

N2 - OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons' ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3-6). Grade 1 and 2 and Grade 3-5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (<100 cases, P < 0.001), but there was no significant difference between intermediate- and high-volume centres under this aspect. Low-volume centres were significantly more likely to convert due to issues with difficult local anatomy, but not significantly so for bleeding. Conversion, lower case-volume, comorbidity burden, male gender, adhesions, blood loss, operative time, sealants and epidural analgesia were significantly associated with increased postoperative morbidity. CONCLUSIONS: VATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

AB - OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons' ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3-6). Grade 1 and 2 and Grade 3-5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (<100 cases, P < 0.001), but there was no significant difference between intermediate- and high-volume centres under this aspect. Low-volume centres were significantly more likely to convert due to issues with difficult local anatomy, but not significantly so for bleeding. Conversion, lower case-volume, comorbidity burden, male gender, adhesions, blood loss, operative time, sealants and epidural analgesia were significantly associated with increased postoperative morbidity. CONCLUSIONS: VATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

KW - Conversion

KW - Morbidity

KW - Postoperative complications

KW - Video-assisted thoracoscopic surgery lobectomy

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U2 - 10.1093/ejcts/ezz187

DO - 10.1093/ejcts/ezz187

M3 - Article

C2 - 31408146

AN - SCOPUS:85075222000

VL - 56

SP - 1097

EP - 1103

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 6

ER -