Effect of gender on perioperative outcomes after robotic-assisted pulmonary lobectomy.
BACKGROUND
Female gender has been associated with worse outcomes after cardiovascular surgery and critical illness. We investigated the effect of gender on perioperative outcomes following robotic-assisted pulmonary lobectomy.


METHODS
We retrospectively analyzed 282 consecutive patients who underwent robotic-assisted pulmonary lobectomy by one surgeon over 53 months. Perioperative outcomes and clinically significant intraoperative and postoperative complications, including respiratory and cardiovascular events, were noted. Chi-Square (χ2), Fisher's exact test, Analysis of Variance (ANOVA), Student'st-test, and Kruskal-Wallis or Mood's median test were used to compare variables, with significance at P≤0.05.


RESULTS
There were 128 men (mean age, 68.8 yr) and 154 women (mean age, 65.9 yr; P=0.02). Women had higher preoperative forced expiratory volume in 1 second as percent of predicted (FEV1%; P=0.001). There were more former smokers in the male cohort (P=0.03) and more nonsmokers in the female cohort (P<0.001). Women had smaller tumors (3.0±0.1vs.3.5±0.2 cm, P=0.04), lower estimated blood loss (EBL) (150±34vs.250±44 mL, P<0.001), and shorter operative time (168±6vs.196±7 min, P=0.01). Rates of intraoperative complications (7.1%vs.8.6%, P=0.65) and of conversion to open lobectomy (7.8%vs.8.6%; P=0.81) were similar between genders. Postoperative complications were fewer in women (27.9%vs.44.5%; P=0.004), the most common of which, in both women and men, were prolonged air leak for ≥7 days (13.0%vs.22.7%, P=0.03), atrial fibrillation (7.1%vs.14.8%, P=0.04), and pneumonia (7.8%vs.10.2%, P=0.49). Hospital length of stay (LOS) (4±0.3vs.5±0.5 days) was also shorter for women (P=0.02). Despite the higher postoperative complication rate in men, in-hospital mortality did not differ between genders (P=0.23). Multivariable analyses did not identify female gender as an independent predictor of post-operative complications.


CONCLUSIONS
Female gender was associated with rates of intraoperative complications and of conversion to open lobectomy as low as those for men, but with better perioperative outcomes, lower risk of intraoperative bleeding, and fewer postoperative complications. Thus, robotic-assisted pulmonary lobectomy is feasible and safe for women.
Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.
Jessica R
JR
Glover
Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA.
Frank O
FO
Velez-Cubian
Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA.
Wei Wei
WW
Zhang
Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.
Kavian
K
Toosi
Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Tawee
T
Tanvetyanon
Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.
Emily P
EP
Ng
Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Carla C
CC
Moodie
Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Joseph R
JR
Garrett
Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA;; Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA;; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA.
Jacques P
JP
Fontaine
Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA;; Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA;; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA.
Eric M
EM
Toloza
Gender; lobectomy; lung cancer; outcomes; robotic