Retrospective Observational Study into the Early Causes of Death Following Surgery for NSCLC
31 August 2018
31 October 2018
26 December 2018 (online)
Introduction Respiratory failure has historically been the major cause of mortality after elective lung resections. With improved intubation using fiber-optic scopes, better preoperative respiratory risk assessment, more advanced anesthetic single lung ventilation, and minimally invasive surgical technique, this may have changed. Our objective was to assess the main causes of mortality over the past 10 years in patients undergoing elective lung surgery in a major UK center.
Materials and Methods A retrospective unit data search was made for all deaths during the 10-year period between January 2007 and December 2016 inclusive. All inpatient deaths within 30 days of an elective anatomical lung resection for lung malignancies were included.
Results Three-thousand three-hundred sixteen lung resections for malignancy were performed in the 10-year period. There were 44 (1.3%) deaths during this period, 27 (61.4%) after open lobectomies, 8 (18.2%) after video-assisted thoracoscopic surgery lobectomies, 5 (11.4%) after sleeve lobectomies, and 4 (9%) after pneumonectomies. Causes of death included 24 (54.5%) respiratory failure, 10 (22.7%) ischemic bowel, 4 (9%) coronary events, 2 (4.5%) strokes, 2 (4.5%) on table hemorrhage, 1 (2.3%) massive pulmonary embolus, and 1 (2.3%) postoperative hemorrhage.
Conclusion Although respiratory failure is still a major cause of mortality in the postoperative patient, bowel ischemia has been found to be the second greatest cause of death. This study highlights the need to identify those at risk of this fatal complication during preoperative assessment and their postoperative management.
Keywordslung cancer - thoracic surgery - in-hospital mortality - mesenteric ischemia - atrial fibrillation
All authors fulfil the four criteria according to ICMJE. The main contributions are listed below:
JS: main author of the manuscript; FM: substantial contributions to the design of the work; M A-S: acquisition of data for the work; NS: acquisition of data for the work; JK: acquisition of data for the work; LV: drafting the work for important intellectual content; AB: revising it critically for important intellectual content; JP: revising it critically for important intellectual content; TR: substantial contributions to the conception of the work; KH-P: substantial contributions to the conception of the work.
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