Half the deaths after surgery for lung cancer occur after discharge

Abstract

Introduction: Mortality following surgery for lung cancer increases at 90 days. The objective of this study was to determine the rate, factors, time to death, hospital stay until discharge, time to death after discharge and causes of mortality at 90 days following surgery for lung cancer. Methods: A prospective follow-up study was performed in a cohort of 378 patients who underwent surgery for lung cancer between January 2012 and December 2016. Data on preoperative status, postoperative complica- tions, and mortality were collected. Results: Rates of mortality were 1.6% vs. 3.2% at 30 and 90 days, respectively. Half of deaths occurred between 31 and 90 postoperative days following discharge. The variables found to be related to mortality at 90 days were a Charlson Index > 3 (p < 0.001), a history of stroke (p = 0.036), postoperative pneumonia (p = 0.001), postoperative pulmonary or lobar collapse (p = 0.001), reintubation (p < 0.001) and postoperative arrhythmia (p = 0.0029). The risk of mortality was also observed to be associated with the type of surgical technique –being higher for thoracotomy as compared to video-assisted thoracoscopy (VATS) (p = 0.011) –, and hospital readmission after discharge (p < 0.001). Adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Multivariate analysis re- vealed that a Charlson Index > 3 (p = 0.001) OR 2.0 (1.55,2.78), a history of stroke (p = 0.018) OR 5.1 (1.81, 32.96) and postoperative pulmonary or lobar collapse (p = 0.001) OR 8.5 (2.41,30.22) were independent prognostic factors of mortality. The most common causes of death were related to respiratory (58.3%) and cardiovascular (33.2%) compli- cations. Conclusions: Mortality at 90 days following surgery for lung cancer doubles 30-day mortality, which is a relevant finding of which both, patients and healthcare should be aware. Half the deaths within 90 days after surgery for lung cancer occur after discharge. Specific outpatient follow-up programs should be designed for patients at a higher risk of 90-day mortality.

La mortalidad a los 90 días tras cirugía por cáncer de pulmón alcanza el 3,2%, duplicando la registrada a los 30 días (1,6%). En un estudio prospectivo con 378 pacientes, se identificaron como factores independientes de mortalidad: un índice de Charlson >3, antecedentes de ictus y atelectasia postoperatoria. La mitad de los fallecimientos ocurrió tras el alta hospitalaria, y las causas principales fueron complicaciones respiratorias (58,3%) y cardiovasculares (33,2%). Se recomienda establecer programas de seguimiento ambulatorio específicos para pacientes con mayor riesgo de mortalidad a 90 días.