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Major intraoperative complications during video-assisted thoracoscopic anatomical lung resections: an intention-to-treat analysis.
- Source :
-
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2015 Oct; Vol. 48 (4), pp. 588-98; discussion 599. - Publication Year :
- 2015
-
Abstract
- Objectives: A multicentre evaluation of the frequency and nature of major intraoperative complications during video-assisted thoracoscopic (VATS) anatomical resections.<br />Methods: Six European centres submitted their series of consecutive anatomical lung resections with the intention to treat by VATS. Conversions to thoracotomy, vascular injuries and major intraoperative complications were studied in relation to surgeons' experience. Major complications included immediate life-threatening complications (i.e. blood loss of more than 2 l), injury to proximal airway or other organs or those leading to unplanned additional anatomical resections. All cases were discussed by a panel and recommendations were drafted.<br />Results: A total of 3076 patients were registered. Most resections (90%, n = 2763) were performed for bronchial carcinoma. There were 3 intraoperative deaths, including 1 after conversion for technical reasons. In-hospital mortality was 1.4% (n = 43). Conversion to open thoracotomy was observed in 5.5% (n = 170), of whom 21.8% (n = 37) were for oncological reasons, 29.4% (n = 50) for technical reasons and 48.8% (n = 83) for complications. Vascular injuries were reported in 2.9% (n = 88) patients and led to conversion in 2.2% (n = 70). In 1.5% (n = 46), major intraoperative complications were identified. These consisted of erroneous transection of bronchovascular structures (n = 9); injuries to gastrointestinal organs (n = 5) or proximal airway (n = 6); complications requiring additional unplanned major surgery (n = 9) or immediate life-threatening complications (n = 17). Twenty-three percent of the in-hospital mortalities (n = 10/43) were related to major intraoperative complications. Eight pneumonectomies (five intraoperative and three postoperative at 0.3%) were a consequence of a major complication. Surgeon's experience was related to non-oncological conversions, but not to vascular injuries or major complications in a multivariable logistic regression analysis.<br />Conclusion: Major intraoperative complications during VATS anatomical lung resections are infrequent, seem not to be related to surgical experience but have an important impact on patient outcome. Constant awareness and a structured plan of action are of paramount importance to prevent them.<br /> (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Subjects :
- Aged
Cohort Studies
Confidence Intervals
Europe
Female
Follow-Up Studies
Humans
Intention to Treat Analysis
Intraoperative Complications mortality
Intraoperative Complications surgery
Kaplan-Meier Estimate
Lung Neoplasms pathology
Male
Middle Aged
Odds Ratio
Registries
Reoperation methods
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Thoracic Surgery, Video-Assisted methods
Thoracotomy methods
Thoracotomy mortality
Cause of Death
Hospital Mortality trends
Intraoperative Complications diagnosis
Lung Neoplasms mortality
Lung Neoplasms surgery
Thoracic Surgery, Video-Assisted adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1873-734X
- Volume :
- 48
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 26385060
- Full Text :
- https://doi.org/10.1093/ejcts/ezv287