title: A model for morbidity after lung resection in octogenarians.
abstract: OBJECTIVE
  Age is an important risk factor for morbidity after lung resection. This study was performed to identify specific risk factors for complications after lung resection in octogenarians.
  
  
  METHODS
  A prospective database containing patients aged 80 years or older, who underwent lung resection at a single institution between January 2000 and June 2009, was reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed. Morbidity was measured as a patient having any perioperative event as defined by the Society of Thoracic Surgeons General Thoracic Surgery Database. A multivariable risk model for morbidity was developed using a panel of established preoperative and operative variables. Survival was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  During the study period, 193 patients aged 80 years or older (median age 82 years) underwent lung resection: wedge resection in 77, segmentectomy in 13, lobectomy in 96, bilobectomy in four, and pneumonectomy in three. Resection was accomplished via thoracoscopy in 149 patients (77%). Operative mortality was 3.6% (seven patients) and morbidity was 46% (89 patients). A total of 181 (94%) patients were discharged directly home. Postoperative events included atrial arrhythmia in 38 patients (20%), prolonged air leak in 24 patients (12%), postoperative transfusion in 22 patients (11%), delirium in 16 patients (8%), need for bronchoscopy in 14 patients (7%), and pneumonia in 10 patients (5%). Significant predictors of morbidity by multivariable analysis included resection greater than wedge (odds ratio 2.98, p=0.006), thoracotomy as operative approach (odds ratio 2.6, p=0.03), and % predicted forced expiratory volume in 1s (odds ratio 1.28 for each 10% decrement, p=0.01).
  
  
  CONCLUSIONS
  Octogenarians can undergo lung resection with low mortality. Extent of resection, use of a thoracotomy, and impaired lung function increase the risk of complications. Careful evaluation is necessary to select the most appropriate approach in octogenarians being considered for lung resection.
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC 27710, USA. berry037@mc.duke.edu
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.forename: Betty C
authors.initials: BC
authors.lastname: Tong
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
mesh_terms: D000369:Aged, 80 and over; D015897:Comorbidity; D004812:Epidemiologic Methods; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D015233:Models, Statistical; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D013906:Thoracoscopy; D016896:Treatment Outcome