title: Quantifying the safety benefits of wedge resection: a society of thoracic surgery database propensity-matched analysis.
abstract: BACKGROUND
  Wedge resection is often used instead of anatomic resection in an attempt to mitigate perioperative risk. In propensity-matched populations, we sought to compare the perioperative outcomes of patients undergoing wedge resection with those undergoing anatomic resection.
  
  
  METHODS
  The Society of Thoracic Surgery database was reviewed for stage I and II non-small cell lung cancer patients undergoing wedge resection and anatomic resection to analyze postoperative morbidity and mortality. Propensity scores were estimated using a logistic model adjusted for a variety of risk factors. Patients were then matched by propensity score using a greedy 5- to 1-digit matching algorithm, and compared using McNemar's test.
  
  
  RESULTS
  Between 2009 and 2011, 3,733 wedge resection and 3,733 anatomic resection patients were matched. The operative mortality was 1.21% for wedge resection versus 1.93% for anatomic resection (p=0.0118). Major morbidity occurred in 4.53% of wedge resection patients versus 8.97% of anatomic resection patients (p<0.0001). A reduction was noted in the incidence of pulmonary complications, but not cardiovascular or neurologic complications. There was a consistent reduction in major morbidity regardless of age, lung function, or type of incision. Mortality was reduced in patients with preoperative forced expiratory volume in 1 second less than 85% predicted.
  
  
  CONCLUSIONS
  Wedge resection has a 37% lower mortality and 50% lower major morbidity rate than anatomic resection in these propensity-matched populations. The mortality benefit is most apparent in patients with forced expiratory volume in 1 second less than 85% predicted. These perioperative benefits must be carefully weighed against the increase in locoregional recurrence and possible decrease in long-term survival associated with the use of wedge resection for primary lung cancers.
authors.affiliation: Division of Thoracic and Esophageal Surgery, University Hospitals Case Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio. Electronic address: philip.linden@uhhospitals.org.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Linden
authors.affiliation: Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Division of Thoracic and Esophageal Surgery, University Hospitals Case Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Perry
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Paramita
authors.initials: P
authors.lastname: Saha-Chaudhuri
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Shubin
authors.initials: S
authors.lastname: Sheng
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sunghee
authors.initials: S
authors.lastname: Kim
authors.affiliation: Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mark
authors.initials: M
authors.lastname: Onaitis
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D057216:Propensity Score; D011446:Prospective Studies; D012307:Risk Factors; D012955:Societies, Medical; D015996:Survival Rate / Q000639:trends; D013903:Thoracic Surgery; D019616:Thoracic Surgical Procedures / Q000592:standards*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology