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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 551-554, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LJ Kohman, JA Meyer, PM Ikins and RP Oates
Over a period of 12 1/2 years, 476 patients underwent thoracotomy for lung
cancer at two affiliated hospitals. Hospital mortality for all patients was
5.25% and for those undergoing pulmonary resection, 5.67%. Hospital
mortality is more indicative of true risk than is the 30 day mortality
figure, which we regard as arbitrary and misleadingly low. Thirty-seven
preoperative risk factors were analyzed for their effects on both morbidity
and mortality, and 12 classes of postoperative complications were analyzed
for their effect on mortality. All preoperative risk factors together
accounted only for 12% of the risk of mortality (R2 by multiple regression
analysis). Only three of these factors bore a significant association with
mortality: patient age 60 years or over (p less than 0.05), need for
pneumonectomy (p less than 0.005), and premature ventricular contractions
on the admission electrocardiogram (p less than 0.05). All the listed
postoperative complications together accounted for only 28% of the risk of
mortality. Of these complications, four showed a significant association
with postoperative death: infectious complications (pneumonia and empyema)
and cardiovascular accidents (pulmonary embolism and myocardial
infarction). In both analyses, the remainder of the risk of death must be
attributed either to factors not considered or to purely random factors. It
follows that much the greater part of the risk of death from surgical
treatment of lung cancer could not be predicted from the preoperative
status of the patients.
ARTICLES
Random versus predictable risks of mortality after thoracotomy for lung cancer
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