title: Sex differences in early outcomes after lung cancer resection: analysis of the Society of Thoracic Surgeons General Thoracic Database.
abstract: OBJECTIVE
  Women with lung cancer have superior long-term survival outcomes compared with men, independent of stage. The cause of this disparity is unknown. For patients undergoing lung cancer resection, these survival differences could be due, in part, to relatively better perioperative outcomes for women. This study was undertaken to determine differences in perioperative outcomes after lung cancer surgery on the basis of sex.
  
  
  METHODS
  The Society of Thoracic Surgeons' General Thoracic Database was queried for all patients undergoing resection of lung cancer between 2002 and 2010. Postoperative complications were analyzed with respect to sex. Univariable analysis was performed, followed by multivariable modeling to determine significant risk factors for postoperative morbidity and mortality.
  
  
  RESULTS
  A total of 34,188 patients (16,643 men and 17,545 women) were considered. Univariable analysis demonstrated statistically significant differences in postoperative complications favoring women in all categories of postoperative complications. Women also had lower in-hospital and 30-day mortality (odds ratio, 0.56; 95% confidence interval, 0.44-0.71; P < .001). Multivariable analysis demonstrated that several preoperative conditions independently predicted 30-day mortality: male sex, increasing age, lower diffusion capacity, renal insufficiency, preoperative radiation therapy, cancer stage, extent of resection, and thoracotomy as surgical approach. Coronary artery disease was an independent predictor of mortality in women but not in men. Thoracotomy as the surgical approach and preoperative radiation therapy were predictive of mortality for men but not for women. Postoperative prolonged air leak and empyema predicted mortality in men but not in women.
  
  
  CONCLUSIONS
  Women have lower postoperative morbidity and mortality after lung cancer surgery. Some risk factors are sex-specific with regard to mortality. Further study is warranted to determine the cause of these differences and to determine their effect on survival.
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC. Electronic address: betty.tong@duke.edu.
authors.forename: Betty C
authors.initials: BC
authors.lastname: Tong
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.
authors.forename: Andrzej S
authors.initials: AS
authors.lastname: Kosinski
authors.affiliation: St Luke's Health Network, Bethlehem, Pa.
authors.forename: William R
authors.initials: WR
authors.lastname: Burfeind
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D054624:Health Status Disparities; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012955:Societies, Medical; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
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