Y. Sanaiha1, K. Bailey1, Y. Seo1, E. Aguayo1, V. Dobaria1, A. Iyengar1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Cardiac Surgery,Los Angeles, CA, USA
Introduction:
Cardiovascular complications contribute significantly to the morbidity and resource utilization after pulmonary resections. Rapid growth of healthcare expenditure in the US, a third of which is attributable to surgical procedures, has prompted national initiatives to curtail costs and reduce postoperative complications. Maturation of less-invasive technologies such as video assisted(VA) and robotic assisted(RA) thoracoscopic surgery aim at improving postoperative outcomes by reducing the trauma of surgery, fluid shifts, and hemorrhage. However, the impact of such techniques on the incidence of cardiovascular complications remains unexplored. Since thoracic operations are regarded as high risk for cardiovascular complications, the present work aimed to evaluate changes in cardiovascular complications following open, thoracoscopic and robotic assisted lobectomies in the US.
Methods:
We performed a retrospective analysis of the Nationwide Inpatient Sample (NIS) for patients having elective open, video assisted and robotic assisted thoracoscopic lobectomy during 2008-2014. Chi-squared analysis was used to compare demographic and hospital characteristics between groups. Logistic regression was performed to determine predictors of in-hospital mortality, postoperative myocardial infarction (POMI) and postoperative pulmonary embolus
Results:
238,647 patients underwent pulmonary lobectomy over the study period(154, 644 open thoracotomy, 72517 VATS, 8486 RATS). Post-operative myocardial infarction rates were similar for VA and RA thoracoscopic groups. In contrast, rates of pulmonary embolism(PE) were higher for patients undergoing RA lobectomy(0.41% vs 0.77%, p<0.0001). Mortality rates for open and robotic groups appear to be uptrending, though this these trends do not reach statistical significance. Thoracoscopic mortality rate is increasing from 0.013% to 0.025%(p=0.025). Utilization of the thoracotomy approach has steadily decreased from 65.5% to 49.8% of all lobectomies(p=0.046). Concomitantly VATS comprises a greater percentage of lobectomies since 2010(from 32.9% to 42.2%). Regression analysis adjusting for patient co-morbidities and hospital characteristics indicates that for thoracotomy approach is associated with increased odds of POMI, postoperative PE, and mortality(POMI OR 1.3, p=0.008; PE OR 1.8, p<0.001; mortality OR 1.9, p<0.001). Advanced age and Elixhauser score greater than 3 also increase odds of the outcomes of interest. Female gender is the only consistent factor that appears to be protective against POMI, PE, and mortality.
Conclusion:
While post-operative myocardial infarction and pulmonary embolus are not increase in incidence. The association of these post-operative complications with minimally invasive techniques may reflect a shift in patient selection. Patient and hospital characteristics modeled in the current study do not effectively predict risk factors for these complications beyond surgical technique, age and comorbidity.