title: Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends.
abstract: BACKGROUND
  Smoking is a common risk factor for chronic obstructive pulmonary disease (COPD), cardiovascular disease, and lung cancer. In this observational study, we examined the impact of COPD severity and time-related changes in early outcome after lung cancer resection.
  
  
  METHODS
  Over a 15-year period, we analyzed an institutional registry including all consecutive patients undergoing surgery for lung cancer. Using the receiver-operating characteristic (ROC) curve, we analyzed the relationship between forced expiratory volume in 1 second (FEV1) and postoperative mortality and respiratory morbidity. Multiple regression analysis has also been applied to identify other risk factors.
  
  
  RESULTS
  A preoperative FEV1 less than 60% was a strong predictor for respiratory complications (odds ratio [OR] = 2.7, confidence interval [CI]: 1.3 to 6.6) and 30-day mortality (OR = 1.9, CI: 1.2 to 3.9), whereas thoracic epidural analgesia was associated with lower mortality (OR = 0.4; CI: 0.2 to 0.8) and respiratory complications (OR = 0.6; CI: 0.3 to 0.9). Mortality was also related to age greater than 70 years, the presence of at least three cardiovascular risk factors, and pneumonectomy. From the period 1990 to 1994, to 2000 to 2004, we observed significant reductions in perioperative mortality (3.7% versus 2.4%) and in the incidence of respiratory complications (18.7% versus 15.2%), that was associated with a higher rate of lesser resection (from 11% to 17%, p < 0.05) and increasing use of thoracic epidural analgesia (from 65% to 88%, p < 0.05).
  
  
  CONCLUSIONS
  Preoperative FEV1 less than 60% is a main predictor of perioperative mortality and respiratory morbidity. Over the last 5-year period, diagnosis of earlier pathologic cancer stages resulting in lesser pulmonary resection as well as provision of continuous thoracic epidural analgesia have contributed to improved surgical outcome.
authors.affiliation: Department of Anesthesiology, University Hospital of Geneva, Geneva, Switzerland. marc-joseph.licker@hcuge.ch
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Licker
authors.forename: Igor
authors.initials: I
authors.lastname: Widikker
authors.forename: John
authors.initials: J
authors.lastname: Robert
authors.forename: Jean-George
authors.initials: JG
authors.lastname: Frey
authors.forename: Anastase
authors.initials: A
authors.lastname: Spiliopoulos
authors.forename: Christoph
authors.initials: C
authors.lastname: Ellenberger
authors.forename: Alexandre
authors.initials: A
authors.lastname: Schweizer
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tschopp
mesh_terms: D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000453:epidemiology; D013908:Thoracotomy; D016896:Treatment Outcome