title: High-risk patients and postoperative complications following video-assisted thoracic surgery lobectomy: a case-matched comparison with lower-risk counterparts†.
abstract: OBJECTIVE
  To assess the postoperative incidence of major complications in high-risk patients following video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer compared with their lower risk counterparts.
  
  
  METHODS
  A retrospective analysis on prospectively collected data of 348 consecutive patients subjected to VATS lobectomy (August 2012-September 2014) was performed. Patients were defined as high risk if one or more of the following characteristics were present: age >75 years, forced expiratory volume in 1 s (FEV1) <50%, carbon monoxide lung diffusion capacity (DLCO) <50%, history of coronary artery disease (CAD). Severity of complications was graded using the Thoracic Morbidity and Mortality (TM&M) score; major complications were defined if the TM&M score was greater than 2. The propensity score was used to match high-risk patients with their lower risk counterparts in order to minimize the influence of other confounders on outcome. The following variables were used to construct the propensity score: gender, side of operation, body mass index, American Society of Anaesthesiologists score, Eastern Cooperative Oncology Group score, Charlson's Comorbidity Index, number of functioning segments resected.
  
  
  RESULTS
  The high-risk group consisted of 141 patients (age >75 years: 84 patients; FEV1 <50: 14 patients; DLCO <50: 25 patients; history of CAD: 37 patients). The propensity score yielded two groups of 135 patients (high-risk vs low-risk) well matched for several baseline characteristics except for a lower performance status in the higher-risk group. Compared with their low-risk counterparts, high-risk patients had a higher incidence of cardiopulmonary complications (28 cases, 21% vs 14 cases, 10%; P < 0.0001) and major cardiopulmonary complications (12 cases, 9% vs 3 cases, 2%; P < 0.0001). Postoperative stay was 3 days longer in high-risk patients (8.6 vs 5.5 days, P = 0.0031). The 30-day or in-hospital mortality rates were not different between the two groups (2 cases, 1.5% vs 3 cases, 2.2%, P = 0.93).
  
  
  CONCLUSIONS
  The incidence of major complications after VATS lobectomy in high-risk patients is low, but not negligible. This information can be used when discussing surgical risk with the patient during preoperative counselling.
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK sandri.alberto@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Sandri
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK.
authors.forename: Kostas
authors.initials: K
authors.lastname: Papagiannopoulos
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Milton
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK.
authors.forename: Nilanjan
authors.initials: N
authors.lastname: Chaudhuri
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Kefaloyannis
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pompili
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Tentzeris
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital Bexley Wing, Leeds, UK.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000401:mortality
keywords: Complications; High-risk patients; Lung cancer; Video-assisted thoracoscopic surgery lobectomy