title: Morbidity of lung resection after prior lobectomy: results from the Veterans Affairs National Surgical Quality Improvement Program.
abstract: BACKGROUND
  Lobectomy is the current standard operation for localized lung cancer. Patients who undergo lobectomy have a 1% to 2% chance per year of developing a second lung cancer. The risks of repeat lung resection have not been well quantified or analyzed. We used a national, prospectively recorded database to evaluate the complication rate and risk factors in this population.
  
  
  METHODS
  The Veterans Affairs National Surgical Quality Improvement Program Database was queried for all patients who underwent lobectomy, followed by an additional lung resection, between 1994 and 2002. Preoperative variables, intraoperative variables, and complications were analyzed. Pulmonary function data were not collected.
  
  
  RESULTS
  Excluding 17 patients who underwent repeat resection for complications of lobectomy, 186 patients underwent 191 repeat resections. The 30-day mortality was 11%; the complication rate was 19%. Mortality for pneumonectomy was 34%, lobectomy, 7%; segmentectomy, 0%; and wedge resection, 6%. The most frequent complications were pneumonia (9%), reintubation (8%), ventilator dependence (6%), cardiac arrest (3%), dysrhythmia (3%), and sepsis (3%). Multivariate analysis revealed that operative time exceeding 2 hours, preoperative dyspnea at rest or with minimal exertion, and white blood cell count of more than 10,000/mm3 were predictors of complication. Presence of a contaminated/infected case, pneumonectomy, and intraoperative transfusion were predictors of death. Age, complications from prior lobectomy, time interval between lobectomy and repeat resection, smoking history, other comorbidities, and preoperative laboratory values were not independent predictors.
  
  
  CONCLUSIONS
  Repeat lung resection after lobectomy carries an 11% overall mortality predicted by the presence of a contaminated/infected case, need for intraoperative transfusion, and pneumonectomy versus a lesser resection.
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. plinden@partners.org
authors.forename: Philip A
authors.initials: PA
authors.lastname: Linden
authors.forename: Beow Y
authors.initials: BY
authors.lastname: Yeap
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Chang
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Michael T
authors.initials: MT
authors.lastname: Jaklitsch
authors.forename: Shukri
authors.initials: S
authors.lastname: Khuri
authors.forename: David J
authors.initials: DJ
authors.lastname: Sugarbaker
authors.forename: Raphael
authors.initials: R
authors.lastname: Bueno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000401:mortality; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D012086:Reoperation / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000592:standards*; D013530:Surgical Wound Infection / Q000401:mortality; D017749:Total Quality Management; D065227:Transfusion Reaction; D014481:United States; D014493:United States Department of Veterans Affairs