title: Predictive factors for complications of anatomical pulmonary segmentectomies.
abstract: OBJECTIVE
  The role of anatomical pulmonary segmentectomy is increasing, but there are few data about its complication rate. We have analysed the postoperative morbidity, mortality and risk factors in a consecutive series of 228 segmentectomies performed in our department.
  
  
  METHODS
  Between January 2007 and December 2011, 221 patients underwent 228 segmentectomies. There were 99 women (45%) and 122 men (55%). The mean age was 61 years (range 18-86 years). The mean forced expiratory volume in 1 s (FEV1) was 87%, and 30 patients had an FEV1 of ≤60%. Fifty-seven patients had a previous history of pulmonary resection. Indications for segmentectomy were: primary lung cancer (111 cases), metastases (71 cases), benign non-infectious (25 cases) and benign infectious diseases (21 cases). The approach was a posterolateral thoracotomy (Group PLT) in 146 patients (64%) and a thoracoscopy (Group TS) in 82 (36%). The two groups were homogenous in terms of age, gender, indications of surgery and type of segmentectomy.
  
  
  RESULTS
  The mortality rate at 3 months was 1.3% (3 patients). The overall complication rate was 34%. Ten patients were reoperated for the following reasons: haemothorax (4 cases), ischaemia of the remaining segment (3 cases), active bleeding (1 case), prolonged air leak (1 case) and dehiscence of thoracotomy (1 case). The average duration of drainage was 5 days (range 1-34 days) and the average length of stay was 9 days (range 3-126 days). On univariate analysis, FEV1, male gender and thoracotomy were statistically significant risk factors for complications. On multivariate analysis, the same three predictive factors of complications independently of age were found statistically significant: preoperative FEV1 < 60% [odds ratio (OR) = 5.9, 95% CI (2.5-13.7), P < 0.001] male gender [OR = 2.04, 95% CI (1.2-3.6), P < 0.013] and thoracotomy [OR = 2.14, 95% CI (1.33-3.46), P = 0.001].
  
  
  CONCLUSIONS
  Pulmonary anatomical segmentectomies have an acceptable morbidity rate. Postoperative complications are more likely to develop in male gender patients, with FEV1 ≤ 60% and operated by open surgery.
authors.affiliation: Thoracic Department, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Akram
authors.initials: A
authors.lastname: Traibi
authors.forename: Madalina
authors.initials: M
authors.lastname: Grigoroiu
authors.forename: Celia
authors.initials: C
authors.lastname: Boulitrop
authors.forename: Anna
authors.initials: A
authors.lastname: Urena
authors.forename: Cristina
authors.initials: C
authors.lastname: Masuet-Aumatell
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Brian
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Stern
authors.forename: Rym
authors.initials: R
authors.lastname: Zaimi
authors.forename: Dominique
authors.initials: D
authors.lastname: Gossot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000401:mortality; D013908:Thoracotomy / Q000009:adverse effects* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
keywords: Segmentectomy; Thoracoscopy; Thoracotomy; VATS