Lobectomy for treating bronchial carcinoma: analysis of comorbidities and their impact on postoperative morbidity and mortality.
OBJECTIVE
To analyze the impact that comorbidities have on the postoperative outcomes in patients submitted to lobectomy for the treatment of bronchial carcinoma.


METHODS
A retrospective study of 493 patients submitted to lobectomy for the treatment of bronchial carcinoma was conducted, and 305 of those patients met the criteria for inclusion in the final study sample. The surgical technique used was similar in all cases. The Torrington-Henderson scale and the Charlson scale were used to analyze comorbidities and to categorize patients into groups based on degree of risk for postoperative complications or death.


RESULTS
The postoperative (30-day) mortality rate was 2.9%, and the postoperative complications index was 44%. Prolonged air leakage was the most common complication (in 20.6%). The univariate analysis revealed that gender, age, smoking, neoadjuvant therapy and diabetes all had a significant impact on the incidence of complications. The factors found to be predictive of complications were body mass index (23.8 +/- 4.4), forced expiratory volume in one second (74.1 +/- 24%) and the ratio between forced expiratory volume in one second and forced vital capacity (0.65 +/- 0.1). The scales employed proved efficacious in the identification of the risk groups, as well as in drawing correlations with morbidity and mortality (p = 0.001 and p < 0.001). In the multivariate analysis, body mass index and the Charlson index were found to be the principal determinants of complications. In addition, prolonged air leakage was found to be the principal factor involved in mortality (p = 0.01).


CONCLUSIONS
Reductions in forced expiratory volume in one second, in the ratio between forced expiratory volume in one second and forced vital capacity, and in body mass index, as well as a Charlson score of 3 or 4 and a Torrington-Henderson score of 3, were associated with a greater number of postoperative complications in patients submitted to lobectomy for the treatment of bronchial carcinoma. Air leakage was found to be strongly associated with mortality.
Sánchez
Pablo Gerardo
PG
Internal Medicine, Federal University of RioGrande do Sul, Porto Alegre, Brazil.
Vendrame
Giovani Schirmer
GS
Madke
Gabriel Ribeiro
GR
Pilla
Eduardo Sperb
ES
Camargo
José de Jesus Peixoto
Jde J
Andrade
Cristiano Feijó
CF
Felicetti
José Carlos
JC
Cardoso
Paulo Francisco Guerreiro
PF
D000368:Aged; D002283:Carcinoma, Bronchogenic / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*