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A model for morbidity after lung resection in octogenarians.
Mark F Berry1, Mark W Onaitis, Betty C Tong
1Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC 27710, USA. berry037@mc.duke.edu
Summary
Lung resection in octogenarians has low mortality but significant morbidity. Risk factors for complications include extensive resection, thoracotomy, and poor lung function, necessitating careful patient selection.
Area of Science:
- Thoracic Surgery
- Geriatric Medicine
- Pulmonary Medicine
Background:
- Age is a critical determinant of surgical risk, particularly for major procedures like lung resection.
- Octogenarians represent a growing population undergoing thoracic surgery, necessitating a clear understanding of their specific risks.
Purpose of the Study:
- To identify specific risk factors associated with postoperative complications following lung resection in patients aged 80 years and older.
- To evaluate the safety and outcomes of lung resection in the octogenarian population.
Main Methods:
- A prospective database of 193 octogenarian patients undergoing lung resection (2000-2009) was reviewed.
- Preoperative, histopathologic, perioperative, and outcome data were assessed.
- A multivariable risk model was developed to identify predictors of morbidity, defined by the Society of Thoracic Surgeons General Thoracic Surgery Database.
Main Results:
- Overall morbidity was 46%, with common complications including atrial arrhythmia (20%) and prolonged air leak (12%).
- Significant predictors of morbidity included extent of resection beyond wedge (OR 2.98), thoracotomy approach (OR 2.6), and reduced % predicted forced expiratory volume in 1s (OR 1.28 per 10% decrement).
- Operative mortality was 3.6%.
Conclusions:
- Lung resection in octogenarians can be performed with acceptable operative mortality.
- The extent of resection, operative approach (thoracotomy), and impaired pulmonary function are key factors increasing complication risk.
- Careful preoperative evaluation and patient selection are crucial for optimizing outcomes in this elderly cohort.
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