title: Cardiac comorbidity is not a risk factor for mortality and morbidity following surgery for primary non-small cell lung cancer.
abstract: OBJECTIVE
  We examined the effect of cardiac comorbidity on mortality and postoperative complications following surgery for primary non-small cell lung cancer.
  
  
  METHODS
  Between October 2001 to December 2005, 1067 consecutive patients underwent lung resection for primary cancer within a single centre; patient data was collected prospectively. Two hundred and seventy-one patients had a history of cardiac comorbidity, which included 196 angina, 118 myocardial infarction, 36 revascularisation, 10 congestive cardiac failure and 19 rhythm disorders (numbers not mutually exclusive). To account for differences in case-mix we used logistic regression to develop a propensity score for cardiac comorbidity group membership and then performed a propensity-matched analysis. Kaplan-Meier curves were used to assess follow-up mortality.
  
  
  RESULTS
  Patients with cardiac comorbidity were more likely to be hypertensive, have severe dyspnoea, diabetes, current or ex-smokers and were older. After performing propensity matching to account for these differences we successfully matched 199 patients with cardiac comorbidity to 398 patients with no cardiac history. There was no difference in in-hospital mortality (2.5% vs 3%, p=0.73), myocardial infarction (0.5% vs 0.3%, p>0.99), arrhythmia (15.6% vs 14.1%, p=0.62), renal failure (2% vs 1.5%, p=0.65), stroke (0.5% vs 0.3%, p>0.99), respiratory insufficiency (4% vs 3.3%, p=0.64), reintubation (1% vs 2.5%, p=0.35), tracheostomy (4% vs 7.8%, p=0.08), intensive care readmission (8.5% vs 6.5%, p=0.37) and length of stay (8 days vs 8 days, p=0.98). Three-year survival was similar (61.4% vs 56.2%, p=0.39). No differences in outcomes existed with different cardiac conditions.
  
  
  CONCLUSIONS
  With careful assessment and patient selection, patients with cardiac comorbidity were not found to be at increased risk of mortality and morbidity following lung resection for primary non-small cell lung cancer in a propensity-matched population.
authors.affiliation: Department of Thoracic Surgery, The Cardiothoracic Centre Liverpool, United Kingdom.
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Mishra
authors.forename: Ragini
authors.initials: R
authors.lastname: Pandey
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Shackcloth
authors.forename: James
authors.initials: J
authors.lastname: McShane
authors.forename: Antony D
authors.initials: AD
authors.lastname: Grayson
authors.forename: Martyn H
authors.initials: MH
authors.lastname: Carr
authors.forename: Richard D
authors.initials: RD
authors.lastname: Page
mesh_terms: D000367:Age Factors; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection / Q000941:ethics; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects