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Predictors of prolonged length of stay after lobectomy for lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk-adjustment model.

Publication ,  Journal Article
Wright, CD; Gaissert, HA; Grab, JD; O'Brien, SM; Peterson, ED; Allen, MS
Published in: Ann Thorac Surg
June 2008

BACKGROUND: Few reliable estimations of operative risk exist for lung cancer patients undergoing lobectomy. This study identified risk factors associated with prolonged length of hospital stay (PLOS) after lobectomy for lung cancer as a surrogate for perioperative morbid events. METHODS: The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database was queried for patients with lobectomy for lung cancer. A model of preoperative risk factors was developed by multivariate stepwise logistic regression setting the threshold for PLOS at 14 days. Morbidity was measured as postoperative events as defined in the STS database. Risk-adjusted results were reported to participating sites. RESULTS: From January 2002 to June 2006, 4979 lobectomies were performed for lung cancer at 56 STS sites, and 351 (7%) had a PLOS. They had more postoperative events than patients without PLOS (3.4 vs 1.2; p < 0.0001). Patients with PLOS also had higher mortality than those with normal LOS, at 10.8% (38 of 351) vs 0.7% (33 of 4628; p < 0.0001). Significant predictors of PLOS included age per 10 years (odds ratio [OR], 1.30, p < 0.001), Zubrod score (OR, 1.51; p < 0.001), male sex (OR, 1.45; p = 0.002), American Society of Anesthesiology score (OR, 1.54; p < 0.001), insulin-dependent diabetes (OR. 1.71; p = 0.037), renal dysfunction (OR, 1.79; p = 0.004), induction therapy (OR, 1.65; p = 0.001), percentage predicted forced expiratory volume in 1 second in 10% increments (OR, 0.88; p < 0.001), and smoking (OR, 1.33; p = 0.095). After risk adjustment, twofold interhospital variability existed in PLOS among STS sites CONCLUSIONS: We identified significant predictors of PLOS, a surrogate morbidity marker after lobectomy for lung cancer. This model may be used to provide meaningful risk-adjusted outcome comparisons to STS sites for quality improvement purposes.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2008

Volume

85

Issue

6

Start / End Page

1857 / 1865

Location

Netherlands

Related Subject Headings

  • Survival Analysis
  • Smoking
  • Sex Factors
  • Risk Adjustment
  • Respiratory System
  • Renal Insufficiency
  • Postoperative Complications
  • Pneumonectomy
  • Odds Ratio
  • Models, Statistical
 

Citation

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ICMJE
MLA
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Wright, C. D., Gaissert, H. A., Grab, J. D., O’Brien, S. M., Peterson, E. D., & Allen, M. S. (2008). Predictors of prolonged length of stay after lobectomy for lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk-adjustment model. Ann Thorac Surg, 85(6), 1857–1865. https://doi.org/10.1016/j.athoracsur.2008.03.024
Wright, Cameron D., Henning A. Gaissert, Joshua D. Grab, Sean M. O’Brien, Eric D. Peterson, and Mark S. Allen. “Predictors of prolonged length of stay after lobectomy for lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk-adjustment model.Ann Thorac Surg 85, no. 6 (June 2008): 1857–65. https://doi.org/10.1016/j.athoracsur.2008.03.024.
Wright CD, Gaissert HA, Grab JD, O’Brien SM, Peterson ED, Allen MS. Predictors of prolonged length of stay after lobectomy for lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk-adjustment model. Ann Thorac Surg. 2008 Jun;85(6):1857–65.
Wright, Cameron D., et al. “Predictors of prolonged length of stay after lobectomy for lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk-adjustment model.Ann Thorac Surg, vol. 85, no. 6, June 2008, pp. 1857–65. Pubmed, doi:10.1016/j.athoracsur.2008.03.024.
Wright CD, Gaissert HA, Grab JD, O’Brien SM, Peterson ED, Allen MS. Predictors of prolonged length of stay after lobectomy for lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk-adjustment model. Ann Thorac Surg. 2008 Jun;85(6):1857–1865.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2008

Volume

85

Issue

6

Start / End Page

1857 / 1865

Location

Netherlands

Related Subject Headings

  • Survival Analysis
  • Smoking
  • Sex Factors
  • Risk Adjustment
  • Respiratory System
  • Renal Insufficiency
  • Postoperative Complications
  • Pneumonectomy
  • Odds Ratio
  • Models, Statistical