Thirty-Day Mortality after Lobectomy in Elderly Patients Eligible for Lung Cancer Screening

BACKGROUND:Whether US surgeons have been able to replicate the low mortality rate of 1% after lobectomy experienced by patients treated in the National Lung Screening Trial is unknown.METHODS:To determine current operative 30-day mortality rates after lobectomy, we analyzed American College of Surgeons National Surgical Quality Improvement Program data files from 2005 to 2012.RESULTS:Of the 2,690 patients analyzed, 1,595 underwent open thoracotomy lobectomy and 1,095 underwent video-assisted thoracoscopic lobectomy. Sixty-three postoperative deaths occurred among the 2,690 patients (2.34% overall). The mortality rate for open lobectomy was 3.13% (50 cases) and that for video-assisted thoracoscopic lobectomy was 1.19% (13 cases [odds ratio 2.69, 95% confidence interval: 1.43 to 5.43, p < 0.05). Evaluation of mortality rates between surgical approaches (open versus video-assisted thoracoscopic) was performed by age group: group 1, aged 65 to 69 years (odds ratio 2.72, 95% confidence interval: 1 to 9.4, p < 0.05); group 2, aged 70 to 74 years (odds ratio 4.41, 95% confidence interval: 1.28 to 23.4, p < 0.05); and group 3, aged 75 to 80 years (no difference was found in group 3, p = 0.45).CONCLUSIONS:Among the hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program, operative mortality rates after lobectomy are comparable to the operative mortality rates in the National Lung Screening Trial.