Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit

Powell, Helen; Tata, Laila J.; Baldwin, David R; Stanley, R; Khakwani, Aamir; Hubbard, Richard

doi:10.1136/thoraxjnl-2012-203123

Cited by 154 publications

(129 citation statements)

References 16 publications

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“…It is slightly higher than the 2.1% estimate for VATS procedures from a systematic review by NGUYEN and MEYER [7] and the 1.5% estimate from a recent case series in Edinburgh, UK [4], but lower than a previous summary estimate reported by KREIDER et al [6] (4.5%) (although this included studies with varying mortality end-points). Although comparison of mortality figures depends on case mix, end-points and procedure types, this consistency supports our estimates, and the comparison to mortality post-lobectomy is not insignificant [16]. 90-day mortality was less commonly reported in case series, but our overall estimate of 3.9% was again similar to that in SIGURDSSON et al [20].…”

Section: Discussionsupporting

confidence: 80%

“…Complications were reasonably common, and the most common cause for readmission and death was ILD (likely, but not certain, to represent acute exacerbations). 30-day mortality was 2.4%, which is comparable to the 30-day mortality following lobectomy for nonsmall cell lung cancer (2.3%) (a potentially curative rather than diagnostic operation) [16]. Male sex, increasing age, increasing comorbidity and open surgery were risk factors for mortality.…”

Section: Discussionmentioning

confidence: 48%

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Surgical lung biopsy for the diagnosis of interstitial lung disease in England: 1997–2008

et al. 2016

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International guidelines and new targeted therapies for idiopathic pulmonary fibrosis have increased the need for accurate diagnosis of interstitial lung disease (ILD), which may lead to more surgical lung biopsies. This study aimed to assess the risk of this procedure in patients from the UK.We used Hospital Episodes Statistics data from 1997 to 2008 to assess the frequency of surgical lung biopsy for ILD in England, UK. We identified cardiothoracic surgical patients using International Classification of Diseases revision 10 codes for ILD and Office of Population Censuses and Surveys Classification of Interventions and Procedures version 4 codes for surgical lung biopsy. We excluded those with lung resections or lung cancer. We estimated in-hospital, 30-day and 90-day mortality following the procedure, and linked to cause of death using data from the UK Office of National Statistics.We identified 2820 patients with ILD undergoing surgical lung biopsy during the 12-year period. The number of biopsies increased over the time period studied. In-hospital, 30-day and 90-day mortality were 1.7%, 2.4% and 3.9%, respectively. Male sex, increasing age, increasing comorbidity and open surgery were risk factors for mortality.Surgical lung biopsy for ILD has a similar mortality to lobectomy for lung cancer, and clinicians and patients should understand the likely risks involved. @ERSpublications 30-day mortality after surgical lung biopsy for ILD is 2.4% (similar to lobectomy for lung cancer)

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 48%

Surgical lung biopsy for the diagnosis of interstitial lung disease in England: 1997–2008

et al. 2016

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“…In the work by Powell et al (6) age, procedure type and performance status were identified as the major drivers of post-operative mortality. We therefore performed a post hoc analysis using data from the NLCA on all 15554 patients who underwent curative surgery for NSCLC between 1 st January 2004 and 31 st March 2012 to derive summary tables for 30 and 90 day mortality, stratified by procedure type, age and performance status.…”

Section: Post-hoc Analysis: Summary Tablesmentioning

confidence: 99%

“…In the previous study by Powell et al (6) three hypothetical patients were used to compare the predicted post-operative mortality using Thoracoscore and the NLCA score. This comparison showed that the predicted mortality for low risk patients was very similar but mortality in the medium and high-risk patients were much higher using the NLCA score (likely reflecting the difference between in-hospital and 90 day mortality).…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…(4,5) Despite this some surgical centres in the United Kingdom (UK) use this score routinely presurgery to provide an estimation of risk. Powell et al (6) used the National Lung Cancer Audit (NLCA) linked to Hospital Episode Statistics (HES) to produce a new score to predict 90 day mortality after surgery in those with lung cancer. The aim of the present study is to validate this score, henceforth called the NLCA score, and compare its performance with Thoracoscore in patients with lung cancer using an updated NLCA dataset and the Danish Lung Cancer Registry (DLCR).…”

Section: Introductionmentioning

confidence: 99%

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Predicting death from surgery for lung cancer: A comparison of two scoring systems in two European countries

et al. 2016

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A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. Contributors: EOD was involved in study design, performed the majority of data processing and analysis and drafted the article. ML analysed the data from the DLCR. HP, ML, DB and RH devised the original idea and RH, DB, TM, HP and ML contributed to the design of the 2 study and analysis of the data. All authors were involved in revising the article and approved the article before submission.Research support: This work was supported by the Roy Castle Lung Cancer Foundation, grant number RB08F1. The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. Word count: 2874 1 Abstract ObjectivesCurrent British guidelines advocate the use of risk prediction scores such as Thoracoscore to estimate mortality prior to radical surgery for non-small cell lung cancer (NSCLC). A recent publication used the National Lung Cancer Audit (NLCA) to produce a score to predict 90 day mortality (NLCA score). The aim of this study is to validate the NLCA score, and compare its performance with Thoracoscore. Materials and MethodsWe performed an internal validation using 2858 surgical patients from NLCA and an external validation using 3191 surgical patients from the Danish Lung Cancer Registry (DLCR). We calculated the proportion that died within 90 days of surgery. The discriminatory power of both scores was assessed by a receiver operating characteristic (ROC) and an area under the curve (AUC) calculation. ResultsNinety day mortality was 5% in both groups. AUC values for internal and external validation of NLCA score and validation of Thoracoscore were 0.68 (95% CI 0.63-0.72), 0.60 (95% CI 0.56-0.65) and 0.60 (95% CI 0.54-0.66) respectively. Post-hoc analysis was performed using NLCA records on 15554 surgical patients to derive summary tables for 30 and 90 day mortality, stratified by procedure type, age and performance status. Conclusions 2Neither score performs well enough to be advocated for individual risk stratification prior to lung cancer surgery. It may be that additional physiological parameters are required; however this is a further project. In the interim we propose the use of our summary tables that provide the real-life range of mortality for lobectomy and pneumonectomy.

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A Comparative Effectiveness Analysis of the Implementation of Surgical Safety Checklists in a Tertiary Care Hospital

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Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit

Cited by 154 publications

References 16 publications

Surgical lung biopsy for the diagnosis of interstitial lung disease in England: 1997–2008

Surgical lung biopsy for the diagnosis of interstitial lung disease in England: 1997–2008

Predicting death from surgery for lung cancer: A comparison of two scoring systems in two European countries

A Comparative Effectiveness Analysis of the Implementation of Surgical Safety Checklists in a Tertiary Care Hospital

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