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. 2011 Jun;39(6):989-94.
doi: 10.1016/j.ejcts.2010.09.038. Epub 2011 Jan 26.

A model for morbidity after lung resection in octogenarians

Mark F Berry  1 , Mark W Onaitis, Betty C Tong, David H Harpole, Thomas A D'Amico
Affiliations

A model for morbidity after lung resection in octogenarians

Mark F Berry et al. Eur J Cardiothorac Surg. 2011 Jun.

Abstract

Objective: Age is an important risk factor for morbidity after lung resection. This study was performed to identify specific risk factors for complications after lung resection in octogenarians.

Methods: A prospective database containing patients aged 80 years or older, who underwent lung resection at a single institution between January 2000 and June 2009, was reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed. Morbidity was measured as a patient having any perioperative event as defined by the Society of Thoracic Surgeons General Thoracic Surgery Database. A multivariable risk model for morbidity was developed using a panel of established preoperative and operative variables. Survival was calculated using the Kaplan-Meier method.

Results: During the study period, 193 patients aged 80 years or older (median age 82 years) underwent lung resection: wedge resection in 77, segmentectomy in 13, lobectomy in 96, bilobectomy in four, and pneumonectomy in three. Resection was accomplished via thoracoscopy in 149 patients (77%). Operative mortality was 3.6% (seven patients) and morbidity was 46% (89 patients). A total of 181 (94%) patients were discharged directly home. Postoperative events included atrial arrhythmia in 38 patients (20%), prolonged air leak in 24 patients (12%), postoperative transfusion in 22 patients (11%), delirium in 16 patients (8%), need for bronchoscopy in 14 patients (7%), and pneumonia in 10 patients (5%). Significant predictors of morbidity by multivariable analysis included resection greater than wedge (odds ratio 2.98, p=0.006), thoracotomy as operative approach (odds ratio 2.6, p=0.03), and % predicted forced expiratory volume in 1s (odds ratio 1.28 for each 10% decrement, p=0.01).

Conclusions: Octogenarians can undergo lung resection with low mortality. Extent of resection, use of a thoracotomy, and impaired lung function increase the risk of complications. Careful evaluation is necessary to select the most appropriate approach in octogenarians being considered for lung resection.

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Figures

Figure 1
Figure 1
A) Kaplan-Meier analysis of overall survival after resection of pathologic stage I lung cancer. B) Kaplan-Meier analysis of overall survival after resection of pathologic stage I lung cancer for patients undergoing wedge resection and greater than wedge resection.
See this image and copyright information in PMC

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