title: Malignant pleural mesothelioma and the Society of Thoracic Surgeons Database: an analysis of surgical morbidity and mortality.
abstract: BACKGROUND
  To date, reported surgical morbidity and mortality for pleurectomy/decortication and extrapleural pneumonectomy performed for malignant pleural mesothelioma primarily represent the experience of a few specialized centers. For comparison, we examined early outcomes of pleurectomy/decortication and extrapleural pneumonectomy from a broader group of centers/surgeons participating in the Society of Thoracic Surgeons-General Thoracic Database.
  
  
  METHODS
  All patients in the Society of Thoracic Surgeons-General Thoracic Database (version 2.081, representing 2009-2011) who underwent pleurectomy/decortication or extrapleural pneumonectomy for malignant pleural mesothelioma were identified. Patient characteristics, morbidity, mortality, center volume, and procedure were examined using univariable and multivariable analyses.
  
  
  RESULTS
  A total of 225 patients underwent pleurectomy/decortication (n = 130) or extrapleural pneumonectomy (n = 95) for malignant pleural mesothelioma at 48 centers. Higher volumes of procedures (≥5/y) were performed at 3 pleurectomy/decortication and 2 extrapleural pneumonectomy centers. Patient characteristics were statistically equivalent between pleurectomy/decortication and extrapleural pneumonectomy groups, except those undergoing extrapleural pneumonectomy were younger (63.2 ± 7.8 years vs 68.3 ± 9.5 years; P < .001) and more likely to have received preoperative chemotherapy (30.1% vs 17.8%; P = .036). Major morbidity was greater after extrapleural pneumonectomy, including acute respiratory distress syndrome (8.4% vs 0.8%; P = .005), reintubation (14.7% vs 2.3%; P = .001), unexpected reoperation (9.5% vs 1.5%; P = .01), and sepsis (4.2% vs 0%; P = .03), as was mortality (10.5% vs 3.1%; P = .03). Multivariate analyses revealed that extrapleural pneumonectomy was an independent predictor of major morbidity or mortality (odds ratio, 6.51; P = .001). Compared with high-volume centers, increased acute respiratory distress syndrome was seen in low-volume centers performing extrapleural pneumonectomy (0% vs 12.5%; P = .05).
  
  
  CONCLUSIONS
  Extrapleural pneumonectomy is associated with greater morbidity and mortality compared with pleurectomy/decortication when performed by participating surgeons of the Society of Thoracic Surgeons-General Thoracic Database. Effects of center volume require further study.
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Burt
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA and West Los Angeles VA Medical Center, Los Angeles, Calif.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Cameron
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Mollberg
authors.affiliation: Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC.
authors.forename: Andrzej S
authors.initials: AS
authors.lastname: Kosinski
authors.affiliation: Department of Cardiothoracic Surgery, Oregon Heath and Science University, Portland, Ore.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Schipper
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Shrager
authors.affiliation: Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago, Medicine and Biological Sciences, Chicago, Ill. Electronic address: wvignesw@surgery.bsd.uchicago.edu.
authors.forename: Wickii T
authors.initials: WT
authors.lastname: Vigneswaran
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D016015:Logistic Models; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010997:Pleural Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012955:Societies, Medical; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome