title: The long-term impact of surgical complications after resection of stage I nonsmall cell lung cancer: a population-based survival analysis.
abstract: OBJECTIVE
  Surgical morbidity may influence long-term cancer survival. Because resection of early stage nonsmall cell lung cancer (NSCLC) is primary therapy, we sought to determine the survival impact of surgical complications for elderly patients undergoing resection of stage I NSCLC.
  
  
  METHODS
  Using the linked Surveillance Epidemiology and End Results-Medicare database (2000-2005), we identified elderly patients who underwent lobectomy for stage I NSCLC. We then assessed the unadjusted association between in-hospital, postoperative complications, and long-term survival for patients who survived more than 30 days after resection using the Kaplan-Meier method. Finally, we used Cox proportional hazards regression to evaluate the relationship between postoperative complications and 5-year cancer-specific (CSS) and overall survival (OS) after adjusting for patient, tumor, and treatment characteristics.
  
  
  RESULTS
  We identified 3996 eligible patients. The overall in-hospital, postoperative complication rate was 54.2%. Pulmonary complications were the most common (n = 1464) followed by cardiac (n = 916). Unadjusted 5-year CSS was significantly worse for those who had an in-hospital, postoperative complication (70.9%) compared to those who did not (78.9%, P < 0.001). OS was also significantly worse (P < 0.001) for patients who developed a complication. Complications continued to predict worse 5-year CSS and OS after adjusting for patient, tumor, and treatment characteristics (HR: 1.38, 95% CI, 1.17-1.64).
  
  
  CONCLUSIONS
  The occurrence of in-hospital postoperative complications was an independent predictor of worse 5-year CSS after resection of stage I NSCLC. Importantly, the impact of surgical complications extends well after the initial perioperative period. These findings may help identify important targets for best practice guidelines and quality-of-care measures.
authors: Department of Surgery, University of Minnesota , Minneapolis, MN 55455, USA.
authors: Natasha M
authors: NM
authors: Rueth
authors: Helen M
authors: HM
authors: Parsons
authors: Elizabeth B
authors: EB
authors: Habermann
authors: Shawn S
authors: SS
authors: Groth
authors: Beth A
authors: BA
authors: Virnig
authors: Todd M
authors: TM
authors: Tuttle
authors: Rafael S
authors: RS
authors: Andrade
authors: Michael A
authors: MA
authors: Maddaus
authors: Jonathan
authors: J
authors: D'Cunha