Postoperative pulmonary complications and rehabilitation requirements following lobectomy: a propensity score matched study of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy

• Published in: Interactive cardiovascular and thoracic surgery 2017-06, Vol.24 (6), p.931-937
• Main Authors: Agostini, Paula, Lugg, Sebastian T., Adams, Kerry, Vartsaba, Nelia, Kalkat, Maninder S., Rajesh, Pala B., Steyn, Richard S., Naidu, Babu, Rushton, Alison, Bishay, Ehab
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma, Non-Small-Cell Lung - surgery; Female; Follow-Up Studies; Hospital Mortality - trends; Humans; Length of Stay; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Male; Pneumonectomy - adverse effects; Postoperative Complications - mortality; Postoperative Complications - rehabilitation; Propensity Score; Prospective Studies; Pulmonary Disease, Chronic Obstructive - etiology; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - radiotherapy; Risk Factors; Survival Rate - trends; Thoracic Surgery, Video-Assisted - adverse effects; Thoracotomy - adverse effects; United Kingdom - epidemiology
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivx002

Abstract OBJECTIVES: Video-assisted thoracoscopic surgical (VATS) lobectomy is increasingly used for curative intent lung cancer surgery compared to open thoracotomy due to its minimally invasive approach and associated benefits. However, the effects of the VATS approach on postoperative pulmonary complications (PPC), rehabilitation and physiotherapy requirements are unclear; our study aimed to use propensity score matching to investigate this. METHODS: Between January 2012 and January 2016 all consecutive patients undergoing lobectomy via thoracotomy or VATS were prospectively observed. Exclusion criteria included VATS converted to thoracotomy, re-do thoracotomy, sleeve/bilobectomy and tumour size >7 cm diameter (T3/T4). All patients received physiotherapy assessment on postoperative day 1 (POD1), and subsequent treatment as deemed appropriate. PPC frequency was measured daily using the Melbourne Group Scale. Postoperative length of stay (LOS), high dependency unit (HDU) LOS, intensive therapy unit (ITU) admission and in-hospital mortality were observed. Propensity score matching (PSM) was performed using previous PPC risk factors (age, ASA score, body mass index, chronic obstructive pulmonary disease, current smoking) and lung cancer staging. RESULTS: Over 4 years 736 patients underwent lobectomy with 524 remaining after exclusions; 252 (48%) thoracotomy and 272 (52%) VATS cases. PSM produced 215 matched pairs. VATS approach was associated with less PPC (7.4% vs 18.6%; P