Ninety-Day Mortality After Video-Assisted Thoracoscopic Lobectomy: Incidence and Risk Factors

We evaluated the incidence and risk factors of 90-day mortality rate after video-assisted thoracoscopic (VATS) lobectomy.

Retrospective analysis on 733 VATS lobectomies or segmentectomies (January 2012 to February 2016), including 66 operations converted to open operation. Several patient-related and surgical variables were tested to verify their association with 90-day mortality using univariable and logistic regression analyses. A score was assigned to each variable in the final model by proportionally weighting the regression odds ratios (ORs) and assigning 1 point to the smallest one. A total score was generated for each patient by adding the individual points. The patients were finally grouped into classes of risk.

In-hospital/30-day mortality rate was 1.9% (14 patients). Additionally, 4 patients died after discharge between 30 and 90 days. Total 90-day mortality rate was 2.5% (18 patients). Regression analysis showed that factors significantly associated with 90-day mortality were male sex (OR 12, p = 0.001), carbon monoxide lung diffusion capacity (Dlco) less than 60% (OR 4.8, p =0.001), and operative time longer than 150 minutes (OR 4.2, p = 0.03). A score was developed assigning 1 point to the variables Dlco and operative time and 3 points to the variable male sex. The total score ranged from 0 (155 patients) to 5 points (32 patients). Patients were grouped into five risk classes showing an incremental 90-day mortality rate (class A, 0; class B, 0.38%; class C, 0.93%; class D, 5.65%; class E, 18.75%, p < 0.0001).

Our results represent important information to be shared with the patients during surgical counseling. It can also assist multidisciplinary tumor board discussion about treatment selection.