A prospective risk analysis of contemporary thoracic surgery

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Abstract
OBJECTIVE: The results of surgical therapy can only be accurately judgedif the patients' characteristics and their impact on the outcome are known.The purpose of this study was to identify the risk factors of contemporarythoracic surgery, which could serve as a basis for a risk-matchedcomparison of different surgical techniques. METHODS: The data of 15patients' undergoing thoracic surgery were prospectively documented. Theoutcome of the various operative procedures applied was statisticallycorrelated with the access procedure, sex, age, body mass, dignity ofunderlying disease and six concomitant diseases. RESULTS: Four patientsdied within 30 days of surgery (mortality: 2.6%). Morbidity comprising allcomplications (class I) and morbidity comprising only complications ofconsequence for postoperative therapy (class II) rose with the number ofconcomitant diseases (50%/0% with no concomitant disease, 89%/33% with morethan three concomitant diseases). Univariate testing identified malignantdisease (P = 0.002), male sex (P = 0.003), body mass index of less than 20and more than 27 kg/m of the expected level according to the Quetelet rule(P = 0.013) and a combination of concomitant respiratory andcardiocirculatory disease (P = 0.022) as being associated with class Imorbidity. Male sex was significantly coincident with class II morbidity (P= 0.020). Logistic regression analysis demonstrated that thesecharacteristics also had independent influence on class I morbidity (P =0.022, P = 0.001, P = 0.023, P = 0.028). CONCLUSION: It is concluded thatthese characteristics are important predictors of morbidity of thoracicsurgery. If a non-randomized comparison of the outcome of thoracicoperations or different access strategies like thoracotomy or thoracoscopyis intended, at least these patient features should be documented and usedas a basis for matching pairs.

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