Changes in patient presentation and outcomes for major lung resection over three decades☆

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Abstract
Objective: Growing scrutiny of surgical results for lung cancer has prompted increased evaluation of risk factors and outcomes of resection. We determined how patient preoperative status and outcomes of resection have changed over time to identify opportunities for improving these results. Methods: We reviewed a prospectively collected database of patients undergoing major lung resection 1980–2006. Patient characteristics and immediate outcomes of resection were compared for three-decade periods (1980–1989, 1990–1999, 2000–2006). Data were compared using the Kruskal–Wallis test, chi squared analysis, and logistic regression analysis. Results: One thousand and forty-six patients underwent resection for cancer (862) and other problems. The percentage of female patients increased over time. Some elements of preoperative status worsened, with significant increases in hypertension rate, mean performance status, obesity incidence, mean risk score, and use of induction therapy. Pneumonectomy rates, immediate preoperative tobacco use, and surgery for advanced stages of disease decreased over time. Outcomes improved over time, with significant decreases in operative mortality, cardiopulmonary complications, and overall complications. Risk factors for categories of complications including operative mortality varied according to the time period studied. Conclusions: Outcomes of major lung resection have improved over time despite a worsening of some elements of preoperative status. Maintenance of surgical databases is essential to enable surgeons to provide data consonant with growing demand from payers and patients. The use of current rather than historical lung resection outcomes is vital in assessing risk. Identification of changes in surgical practice patterns helps identify opportunities for improving future outcomes.

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