title: Lethality of cardiovascular events highlights the variable impact of complication type between thoracoscopic and open pulmonary lobectomies.
abstract: BACKGROUND
  This study examines the impact of postoperative complications by type on perioperative mortality in lobectomies performed by thoracoscopic (video-assisted thoracoscopic surgery [VATS]) and open thoracotomy (OPEN) approaches for primary lung cancer.
  
  
  METHODS
  A retrospective analysis of the Healthcare and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database from 2007 to 2010 was performed. Patients with primary lung malignancies undergoing pulmonary lobectomy were selected using International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) codes. Perioperative complications within a 30-day period from the operation were identified and recorded using ICD-9-CM codes. Multivariate statistical analysis was performed using Poisson and logistic regression modeling.
  
  
  RESULTS
  There were 24,253 patients included in the analysis, with 5,223 in the VATS cohort and 19,030 in the OPEN cohort. An increased number of complications were associated with increased mortality in both the VATS and OPEN cohorts. The probability of mortality was higher in the OPEN cohort, with 0 or 1 complication, but this difference was lost as the number of complications increased. When categorized by complication type, pulmonary, cardiovascular, wound-related, systemic, and gastrointestinal complications were commonly associated with mortality in both groups. When comparing the number of complications by type between the VATS and OPEN cohorts, cardiovascular (odds ratio [OR], 2.19; p = 0.001) and wound-related (OR, 1.77; p = 0.041) complications were more strongly associated with mortality in the VATS cohort.
  
  
  CONCLUSIONS
  When cardiovascular complications occur after VATS lobectomy, their impact appears to be more significant than those occurring after OPEN lobectomies. This observation deserves further study because of a likely multifactorial explanation.
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Law
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
authors.affiliation: Department of Biostatistics, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Zuoheng
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Henry S
authors.initials: HS
authors.lastname: Park
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut. Electronic address: anthony.kim@yale.edu.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy