title: Pneumonectomy for lung cancer: contemporary national early morbidity and mortality outcomes.
abstract: OBJECTIVE
  The study objective was to determine contemporary early outcomes associated with pneumonectomy for lung cancer and to identify their predictors using a nationally representative general thoracic surgery database (EPITHOR).
  
  
  METHODS
  After discarding inconsistent files, a group of 4498 patients who underwent elective pneumonectomy for primary lung cancer between 2003 and 2013 was selected. Logistic regression analysis was performed on variables for mortality and major adverse events. Then, a propensity score analysis was adjusted for imbalances in baseline characteristics between patients with or without neoadjuvant treatment.
  
  
  RESULTS
  Operative mortality was 7.8%. Surgical, cardiovascular, pulmonary, and infectious complications rates were 14.9%, 14.1%, 11.5%, and 2.7%, respectively. None of these complications were predicted by the performance of a neoadjuvant therapy. Operative mortality analysis, adjusted for the propensity scores, identified age greater than 65 years (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5-2.9; P < .001), underweight body mass index category (OR, 2.2; 95% CI, 1.2-4.0; P = .009), American Society of Anesthesiologists score of 3 or greater (OR, 2.310; 95% CI, 1.615-3.304; P < .001), right laterality of the procedure (OR, 1.8; 95% CI, 1.1-2.4; P = .011), performance of an extended pneumonectomy (OR, 1.5; 95% CI, 1.1-2.1; P = .018), and absence of systematic lymphadenectomy (OR, 2.9; 95% CI, 1.1-7.8; P = .027) as risk predictors. Induction therapy (OR, 0.63; 95% CI, 0.5-0.9; P = .005) and overweight body mass index category (OR, 0.60; 95% CI, 0.4-0.9; P = .033) were protective factors.
  
  
  CONCLUSIONS
  Several risk factors for major adverse early outcomes after pneumonectomy for cancer were identified. Overweight patients and those who received induction therapy had paradoxically lower adjusted risks of mortality.
authors.affiliation: Department of Thoracic Surgery, North Hospital - APHM, Aix-Marseille University, Marseille, France. Electronic address: pathomas@ap-hm.fr.
authors.forename: Pascal A
authors.initials: PA
authors.lastname: Thomas
authors.affiliation: Department of Public Health, North Hospital, EA 3279 Research Unit, Aix-Marseille University, Marseille, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Berbis
authors.affiliation: Department of General and Thoracic Surgery, Rouen, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Baste
authors.affiliation: Department of Thoracic Surgery, HEGP, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec-Barthes
authors.affiliation: Department of Thoracic Surgery, Louis Pradel Hospital, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Tronc
authors.affiliation: Department of Thoracic Surgery, NHC, Strasbourg, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: Department of Thoracic Surgery, Larrey Hospital, Toulouse, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Dahan
authors.affiliation: Methodological Assistance to Clinical Research, Faculty of Medicine, Department of Public Health, Marseille, France.
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
mesh_terms: D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009765:Obesity / Q000401:mortality; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D057216:Propensity Score; D065840:Protective Factors; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome