The differential impact of preoperative comorbidity on perioperative outcomes following thoracoscopic and open lobectomies

Jawitz, Oliver K.; Wang, Zuoheng; Boffa, Daniel J.; Detterbeck, Frank C.; Blasberg, Justin D.; Kim, Anthony W.

doi:10.1093/ejcts/ezw239

Cited by 32 publications

(30 citation statements)

References 23 publications

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“…Similar to the current study, Jawitz and colleagues [17] found among 123,498 lobectomy patients in the National Inpatient Sample that VATS was independently associated with shorter length of stay compared with thoracotomy. The Jawitz study also demonstrated fewer complications and lower in-hospital mortality, but these conclusions were based on univariate analyses [17]. In their propensity score analysis of 2,721 case-matched patients undergoing VATS or open lobectomy between in 2007 and 2013 in the European Society of Thoracic Surgeon database, Falcoz and colleagues [20] found lower incidence of complications and in-hospital death with VATS.…”

Section: Commentsupporting

confidence: 87%

“…There are a number of trials in the literature that have suggested shorter length of stay and lower complication and mortality rates with VATS lung cancer resection [15,[17][18][19][20]. Similar to the current study, Jawitz and colleagues [17] found among 123,498 lobectomy patients in the National Inpatient Sample that VATS was independently associated with shorter length of stay compared with thoracotomy. The Jawitz study also demonstrated fewer complications and lower in-hospital mortality, but these conclusions were based on univariate analyses [17].…”

Section: Commentsupporting

confidence: 84%

“…In their propensity score analysis of 2,721 case-matched patients undergoing VATS or open lobectomy between in 2007 and 2013 in the European Society of Thoracic Surgeon database, Falcoz and colleagues [20] found lower incidence of complications and in-hospital death with VATS. Paul and associates [18] found fewer complications and shorter length of stay with VATS for 1,281 casematched patients undergoing lobectomy between 2002 [15,[17][18][19][20]. Unlike the current study, Paul and associates [18] showed no difference in operative mortality after lobectomy between VATS and thoracotomy.…”

Section: Commentcontrasting

confidence: 63%

“…Hospital-related predictors have also been linked to differences in outcomes [5,15,16]. Hospital volume has been shown to affect length of stay for VATS lobectomy [17], with one study demonstrating that hospitals with higher VATS volume reported shorter length of stay than at lower VATS volume hospitals [15]. Longterm mortality was lower in hospitals with higher lung surgery volume in another study [16].…”

Section: Commentmentioning

confidence: 99%

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Outcomes for Thoracoscopy Versus Thoracotomy Not Just Technique Dependent: A Study of 9,787 Patients

Wolf

Liu

Leoncini

et al. 2018

The Annals of Thoracic Surgery

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Section: Commentsupporting

confidence: 87%

Section: Commentsupporting

confidence: 84%

Section: Commentcontrasting

confidence: 63%

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes for Thoracoscopy Versus Thoracotomy Not Just Technique Dependent: A Study of 9,787 Patients

Wolf

Liu

Leoncini

et al. 2018

The Annals of Thoracic Surgery

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“…The shorter hospital stay is the most important feature, so that VATS is now considered the best approach for elderly patients (57), or with multiple comorbidities (58).…”

Section: The Recent Progressmentioning

confidence: 99%

A glance at the history of uniportal video-assisted thoracic surgery

Mineo¹,

Ambrogi²

2017

J. Vis. Surg.

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In the history of thoracic surgery, the advent of video-assisted thoracic surgery (VATS) had on effect equivalent to that provoked by a true revolution. VATS successfully allowed minor, major and complex procedures for various lung and mediastinal pathologies with small incision instead of the traditional accesses. These small incisions abolished ugly scars, generated less acute and chronic pain, reduced hospital stay and costs, allowed faster return to normal day life activities. Conventional VATS was initially performed

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Province-Wide Analysis of Patient-Reported Outcomes for Stage IV Non-Small Cell Lung Cancer

et al. 2021

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Background. In Ontario, Canada, patient reported outcomes (PRO) evaluation through Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non-small cell lung cancer (NSCLC) is associated with substantial disease and treatment-related morbidity, this province-wide study investigated moderateto-severe symptom burden in this population. Methods. ESAS collected from stage IV NSCLC patients diagnosed between 2007-2018 linked to Ontario provincial healthcare system database were studied. ESAS acquired within 12 months following diagnosis were analyzed and the proportion reporting moderate-to-severe scores (ESAS ≥4) in each domain was calculated. Predictors of moderateto-severe scores were identified using multivariable Poisson regression models with robust error variance. Results. Of 22,799 patients, 13,289 (58.3%) completed ESAS (84,373 assessments) in the year following diagnosis. Patients with older age, high comorbidity, and not receiving active cancer therapy had lower ESAS completion. Majority (94.4%) reported at least 1 moderate-to-severe symptoms. Most prevalent were tiredness (84.1%), low wellbeing (80.7%), low appetite (71.7%), and shortness of breath (67.8%). Most symptoms peaked at diagnosis, while declining, remained high in the following year.On multivariable analyses, comorbidity, low income, non-immigrants, and urban residency were associated with moderate-to-severe symptoms. Moderate-to-severe scores in all ESAS domains aside from anxiety were associated with radiotherapy within 2 weeks prior, while drowsiness, low appetite and wellbeing, nausea, and tiredness were associated with systemic therapy within 2 weeks prior. Conclusion. This province-wide PRO analysis showed moderate-to-severe symptoms were prevalent and persistent among metastatic NSCLC patients, underscoring the need to address supportive measures in this population especially around treatments. The Oncologist ;9999:• • Implications for Practice: This is the largest patient reported outcome (PRO) results among lung cancer patients worldwide. Our results demonstrated the worse moderate-to-severe symptoms among stage IV non-small cell lung cancer patients compared to other patients with metastatic, other malignancies such as breast, gastric, or esophageal cancers assessed with similar methodology. These patients symptom severity also peaked early, and persistently high during 1 year follow-up. Symptoms burden was also associated with recent radiation and systemic treatments. This emphasized the importance of early and sustained PRO collection to detect actionable symptom progression, especially around treatments. Moreover, PRO

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The differential impact of preoperative comorbidity on perioperative outcomes following thoracoscopic and open lobectomies

Abstract: The expected postoperative length of stay for a patient treated by OPEN lobectomy is approximately equal to that of a VATS lobectomy patient with an additional 2-3 comorbidities. The VATS approach remains advantageous with respect to PO-LOS, regardless of the number of comorbidities.

Cited by 32 publications

References 23 publications

Outcomes for Thoracoscopy Versus Thoracotomy Not Just Technique Dependent: A Study of 9,787 Patients

Outcomes for Thoracoscopy Versus Thoracotomy Not Just Technique Dependent: A Study of 9,787 Patients

A glance at the history of uniportal video-assisted thoracic surgery

Province-Wide Analysis of Patient-Reported Outcomes for Stage IV Non-Small Cell Lung Cancer

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