Original article
General thoracic
Predictors of Prolonged Length of Stay after Lobectomy for Lung Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Risk-Adjustment Model

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.
https://doi.org/10.1016/j.athoracsur.2008.03.024Get rights and content

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.

Section snippets

Data Source

The STS started collecting prospective data for the GTSD in 1999 and began issuing reports in 2002. At the time of the latest report, there were 58 participating sites (hospitals, group practices or individual surgeons) and 225 individual surgeons who voluntarily submitted data to the STS GTSD. After annual data harvests, each participant receives a data quality report with the opportunity to amend missing or aberrant data. Data submissions are checked for completeness and compliance within

Results

Patient characteristics are listed in Table 2. There were a similar number of men and woman. Additional comorbidities in the cohort of 4979 patients included a body mass index (BMI) exceeding 30 in 1186 of 4463 (27%), congestive heart failure in 157 (3%), coronary artery disease in 991 (20%), peripheral vascular disease in 452 (9%), cerebral vascular disease in 393 (8%), hypertension in 2659 (53%), and prior thoracic operations in 631 (13%). Comorbidities were present in 4006 patients (80%),

Comment

The STS introduced its thoracic database in 2002 with the intent of using it to continuously measure and improve the quality of thoracic surgical care in North America. After collection of data for more than 50,000 procedures and nearly 5000 lobectomies, the feasibility of risk-prediction models to compare outcome among participating institutions and surgeons has been demonstrated. In the first report of standard resections for lung cancer with data from the STS database, Boffa and associates [6

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