title: Predictors of prolonged length of stay after lobectomy for lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk-adjustment model.
abstract: BACKGROUND
  Few reliable estimations of operative risk exist for lung cancer patients undergoing lobectomy. This study identified risk factors associated with prolonged length of hospital stay (PLOS) after lobectomy for lung cancer as a surrogate for perioperative morbid events.
  
  
  METHODS
  The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database was queried for patients with lobectomy for lung cancer. A model of preoperative risk factors was developed by multivariate stepwise logistic regression setting the threshold for PLOS at 14 days. Morbidity was measured as postoperative events as defined in the STS database. Risk-adjusted results were reported to participating sites.
  
  
  RESULTS
  From January 2002 to June 2006, 4979 lobectomies were performed for lung cancer at 56 STS sites, and 351 (7%) had a PLOS. They had more postoperative events than patients without PLOS (3.4 vs 1.2; p < 0.0001). Patients with PLOS also had higher mortality than those with normal LOS, at 10.8% (38 of 351) vs 0.7% (33 of 4628; p < 0.0001). Significant predictors of PLOS included age per 10 years (odds ratio [OR], 1.30, p < 0.001), Zubrod score (OR, 1.51; p < 0.001), male sex (OR, 1.45; p = 0.002), American Society of Anesthesiology score (OR, 1.54; p < 0.001), insulin-dependent diabetes (OR. 1.71; p = 0.037), renal dysfunction (OR, 1.79; p = 0.004), induction therapy (OR, 1.65; p = 0.001), percentage predicted forced expiratory volume in 1 second in 10% increments (OR, 0.88; p < 0.001), and smoking (OR, 1.33; p = 0.095). After risk adjustment, twofold interhospital variability existed in PLOS among STS sites
  
  
  CONCLUSIONS
  We identified significant predictors of PLOS, a surrogate morbidity marker after lobectomy for lung cancer. This model may be used to provide meaningful risk-adjusted outcome comparisons to STS sites for quality improvement purposes.
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. cdwright@partners.org
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.forename: Henning A
authors.initials: HA
authors.lastname: Gaissert
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Grab
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data*; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D051437:Renal Insufficiency / Q000453:epidemiology / Q000401:mortality; D020379:Risk Adjustment; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D015415:Biomarkers