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Vol. 57. Issue 10.
Pages 625-629 (October 2021)
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Vol. 57. Issue 10.
Pages 625-629 (October 2021)
Original Article
DOI: 10.1016/j.arbr.2021.07.003
Mortality predictors in complicated patients after anatomical lung resection
Variables predictivas de muerte en pacientes complicados tras resección pulmonar anatómica
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M. Teresa Gómez Hernándeza,b,
Corresponding author
, Nuria Novoa Valentína,b, Marta Fuentes Gagoa,b, José Luis Aranda Alcaidea,b, Gonzalo Varela Simób, Marcelo F. Jiménez Lópeza,b
a Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
b Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
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Table 1. Demographic and clinical variables.
Table 2. Logistic regression analysis results.
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Abstract
Introduction

Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections.

Method

Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model.

Results

A total of 2.569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77–0.88).

Conclusions

Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.

Keywords:
Rescue failure
Surgical risk
Postoperative mortality
Lung resection
Resumen
Introducción

El fallo en el rescate (FTR) definido como la tasa de fallecimientos entre los pacientes que sufren una complicación postoperatoria, es considerado un indicador de la calidad de los cuidados quirúrgicos. El objetivo de este estudio es investigar los factores de riesgo asociados al FTR después de resecciones pulmonares anatómicas.

Método

Se incluyeron en el estudio pacientes sometidos a resección pulmonar anatómica en nuestro centro entre 1994 y 2018. Las complicaciones postoperatorias se clasificaron en menores (grados I y II) y mayores (grados IIIa a V) según la clasificación estandarizada de morbilidad postoperatoria. Los casos que fallecieron tras una complicación mayor fueron considerados FTR. Se creó un modelo de regresión logística por pasos para identificar los factores predictores de FTR. Se consideraron variables independientes en el análisis multivariante la edad, índice de masa corporal, comorbilidad cardiaca, renal, cerebrovascular, VEF1ppo%, abordaje VATS, resección extendida, neumonectomía y reintervención. Se construyó una curva ROC no paramétrica para estimar la capacidad predictiva del modelo.

Resultados

Se analizaron 2.569 pacientes. En total, 223 casos (8,9%) tuvieron complicaciones mayores y 49 (22%) no pudieron ser rescatados. Las variables asociadas con FTR fueron: edad (OR: 1,07), antecedente de ACV (OR: 3,53), neumonectomía (OR: 6,67) y reintervención (OR: 12,26). El área bajo la curva de la curva ROC fue 0,82 (IC 95%: 0,77–0,88).

Conclusiones

22% de los pacientes que presentan complicaciones mayores tras la resección pulmonar anatómica en esta serie no sobreviven al alta. La neumonectomía y la reintervención son los factores de riesgo más potentes para FTR.

Palabras clave:
Fallo en el rescate
Riesgo quirúrgico
Mortalidad postoperatoria
Resección pulmonar

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