title: Management and outcome of patients undergoing thoracic surgery in a regional chest medical centre.
abstract: OBJECTIVE
  The main objective of this study was to assess mortality and morbidity after thoracic surgery in a medical centre, without resident chest surgeons and anaesthesiologists, and to determine specific risk factors.
  
  
  METHODS
  A prospective cohort study using a local database which includes patients' clinical characteristics, results of preoperative investigations, surgical and anaesthesia data and all postoperative complications was undertaken. Two hundred and seventy-three consecutive patients undergoing thoracic surgery from 1992 to 1999 were studied. The referral chest medical centre was without resident thoracic surgeons or anaesthesiologists; postoperative care was led by local chest physicians according to standardized protocols and in close collaboration with university-based surgeons and anaesthesiologists.
  
  
  RESULTS
  The majority of patients had lung cancer (71%) and underwent resection of at least one lobe (62%). Thirty-day mortality rate was 2.2% and one or more complications occurred in 74 patients (27%). Three patients had to be transferred to a university hospital for further treatment. Univariate predictors of complications included age (> 70 years), history of smoking, body mass index, as well as the extent and duration of surgery. After multiple logistic regression analysis, smoking (current or past), prolonged surgery (>120 min) and major lung resection (pneumonectomy or bilobectomy) remained the only independent risk factors.
  
  
  CONCLUSIONS
  Overall perioperative mortality and morbidity rates did not exceed those reported from large teaching hospitals. In selected patients, thoracic surgery can be safely performed in a specialized chest medical centre without on-site surgeons and anaesthesiologists.
authors.affiliation: Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Hospital of Geneva, rue Micheli-Ducrest, CH-1211 Geneva 14, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Licker
authors.forename: A
authors.initials: A
authors.lastname: Spiliopoulos
authors.forename: J G
authors.initials: JG
authors.lastname: Frey
authors.forename: M
authors.initials: M
authors.lastname: De Perrot
authors.forename: C
authors.initials: C
authors.lastname: Chevalley
authors.forename: J M
authors.initials: JM
authors.lastname: Tschopp
mesh_terms: D000368:Aged; D000776:Anesthesiology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D008171:Lung Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D019616:Thoracic Surgical Procedures / Q000401:mortality*