Pneumonectomy: the burden of death after discharge and predictors of surgical mortality.

BACKGROUND: Pneumonectomy has the highest mortality rate among resections for lung cancer, with limited literature differentiating predictors of postpneumonectomy in-hospital mortality (IHM) from early postdischarge mortality (PDM). This study aims to examine the burden of death over time and to identify potential predictive factors, including patient comorbidities and hospital and surgeon volumes.

METHODS: Data were abstracted from an Ontario population-based linked database from 2005 to 2011. Proportional mortality and cumulative survival attributable to IHM and 90-day PDM is reported. Logistic and Cox regression analyses examined the role of potential factors related to death. Odds ratios (ORs) and hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.

RESULTS: Of 505 patients who underwent pneumonectomy, the median length of stay was 6 days (1-30 days). IHM was 4.4% (2.9%-6.5%), and 90-day PDM was an additional 6.4% (4.6%-9.0%). Logistic regression showed that congestive heart failure (CHF) (OR, 23.5; range, 4.0-136.0), cerebrovascular disease (OR, 12.5; range, 1.2-128.0), renal disease (OR, 8.8; range, 1.3-60.5), and previous myocardial infarction (MI) (OR, 5.4; range, 1.5-20.0) were predictive of IHM, whereas age (HR, 1.4; range, 1.1-1.7) per year and CHF (HR, 18.0; range, 4.0-79.0) were predictive of PDM. All other factors were not significant.

CONCLUSIONS: PDM represents a distinct and underrecognized burden of postoperative death. More than half of postpneumonectomy mortality occurred after discharge, and the rate remained unchanged over the study period. Patient factors play a major role in both IHM and PDM, whereas institutional and physician volume do not influence outcome, suggesting the importance of patient selection and the need for continued evaluation of mortality.