Thoracic skeletal muscle mass predicts mortality in patients with surgery for pleural empyema: A case control study.

BACKGROUND: This study investigated the role of the thoracic skeletal muscle mass as a marker of sarcopenia on postoperative mortality in pleural empyema. METHODS: All consecutive patients (n = 103) undergoing surgery for pleural empyema in a single tertiary referral center between January 2020 and December 2022 were eligible for this study. Thoracic skeletal muscle mass index (TSMI) was determined from preoperative computed tomography scans. The impact of TSMI and other potential risk factors on postoperative in-hospital mortality was retrospectively analyzed. RESULTS: A total of 97 patients were included in this study. The in-hospital mortality rate was 13.4%. In univariable analysis, low values for preoperative TSMI (p = 0.020), low preoperative levels of thrombocytes (p = 0.027) and total serum protein (p = 0.046) and higher preoperative American Society of Anesthesiologists (ASA) category (p = 0.007) were statistically significant risk factors for mortality. In multivariable analysis, only TSMI (p = 0.038, OR 0.933, 95% CI: 0.875-0.996) and low thrombocytes (p = 0.031, OR 0.944, 95% CI: 0.988-0.999) remained independent prognostic factors for mortality. CONCLUSIONS: TSMI was a significant prognostic risk factor for postoperative mortality in patients with pleural empyema. TSMI may be suitable for risk stratification in this disease with high morbidity and mortality, which may have further implications for the selection of the best treatment strategy.

Influence of psychosocial characteristics of patients and opinions of their relatives on indication for surgical treatment of pectus excavatum.

BACKGROUND: To assess the subjective experience of patients and their parents or relatives about the existing pectus excavatum deformity and to contribute to the definition of indications for surgical treatment of this deformity. METHODS: The initial sample of psychosocial characteristics consisted of self-assessments and observations of patients (and parents) regarding their health, self-image, health care, possible environmental response to their physical appearance, expectations regarding treatment. A modified version of the original Nuss questionnaire on quality of life was used in the psychological part of the examination. RESULTS: The study included a sample of 58 patients aged 10 to 30 years, and a sample of 58 family members of the patient (parents, relatives). The experience of poor emotional status, withdrawals, and bad self-image in patients older than 15 years than younger were significant. The tendency for female patients to have a worse experience is pronounced and significant. The largest percentage of parents have an 'indecisive' or 'weakly expressed' attitude towards surgery. Parents at a significantly higher rate show greater concern for female children. CONCLUSION: A systematic evaluation of the psychosocial perception of patients and their relatives (who will consent for the operation) may be a useful diagnostic assessment before correcting an anterior chest wall malformation.

A randomized controlled trial: Comparison of 14 and 24 French thoracic drainage after minimally invasive lobectomy - MZ 14-24 study.

Background: The optimal placement of a chest drain after video-assisted minimally invasive lobectomy should facilitate the aspiration of air and drainage of fluid. Typically, a conventional 24Ch polyvinyl chloride chest drain is used for this purpose. However, there is currently no scientific literature available on the impact of drain diameter on postoperative outcomes following anatomical lung resection. Methods: This is a prospective, randomized, phase-1 trial that will include 40 patients, which will be randomly assigned into two groups. Group 1 will receive a 24 French chest drain according to current standards, while group 2 will receive a 14 French drain. Primary endpoint of the trial is the incidence of postoperative drainage-related complications, such as obstruction, dislocation, pleural effusion, and reintervention. Secondary endpoints are postoperative pain, chest drainage duration, incidence of complications, and hospital length of stay. The study aims to determine the number of subjects needed to achieve a sufficient test power of 0.8 for a non-inferiority study. Discussion: Thoracic surgery is becoming more and more minimally invasive. One of the remaining unresolved problems is postoperative pain, with the intercostal drain being one of the main contributing factors. Previous data from other studies suggest that the use of small-bore drains can reduce pain and speed up recovery without an increase in drain-related complications. However, no studies have been conducted on patients undergoing anatomic lung resections to date. The initial step in transitioning from larger to smaller drains is to establish the safety of this approach, which is the primary objective of this trial.Trial registration: The study has been registered in the German Clinical Trials Register.Registration number: DRKS00029982.URL: https://drks.de/search/de/trial/DRKS00029982.

Uniportal robotic assisted surgery for anatomical lung resection-First German experience.

BACKGROUND: Uniportal robotic-assisted thoracic surgery (uRATS) has emerged as a promising technique with potential advantages over multiportal approaches. This study aims to evaluate our initial outcomes of uRATS. MATERIAL AND METHODS: Five patients underwent anatomic lung resections with systematic nodal dissection through a uniportal robotic approach by one surgeon. The results were compared to the results of the first five uniportal video-assisted thoracic surgery (uVATS) anatomical resections performed by the same surgeon. RESULTS: No adverse events occurred during the uRATS-procedures. Comparable surgical outcomes were observed between uRATS and uVATS, including hospital stays, complication rates, and blood loss. The average procedural time was slightly but non-significantly longer in the uRATS-group. Average pain-scores were lower in the uRATS group. One patient in each group experienced major postoperative complications, with one case of in-hospital mortality in the uRATS-group. CONCLUSION: The outcomes of uRATS/uVATS were comparable, highlighting the potential and the feasibility of this technique. Prospective studies comparing the learning curves, complication rate and hospital-stay are required in order to justify the superiority of robotics over uVATS.

An update on red blood cell transfusion in non-cardiac thoracic surgery.

Background: The aim of this study was to evaluate risk factors for red blood cell (RBC) transfusion in non-cardiac thoracic surgery. Methods: All patients undergoing non-cardiac thoracic surgery in a single tertiary referral center between January and December 2021 were eligible for this study. Data on blood requests and perioperative RBC transfusion were retrospectively analyzed. Results: A total of 379 patients were included, of whom 275 (72.6%) underwent elective surgery. The overall RBC transfusion rate was 7.4% (elective cases: 2.5%, non-elective cases: 20.2%). Patients with lung resections required transfusion in 2.4% of the cases versus 44.7% in patients undergoing surgery for empyema. In multivariable analysis, empyema (P=0.001), open surgery (P<0.001), low preoperative hemoglobin (P=0.001), and old age (P=0.013) were independent risk factors for RBC transfusion. The best predictor of blood transfusion was preoperative hemoglobin with a cut-off value <10.4 g/dL (sensitivity 82.1%, specificity 86.3%, area under the curve 0.882). Conclusions: The rate of RBC transfusion in current non-cardiac thoracic surgery is low, especially in elective lung resections. In urgent cases and open surgery, transfusion rates remain high, particularly in empyema cases. Preoperative requesting of RBC units should be tailored to patient-specific risk factors.

A systematic review and meta-analysis of retrograde type A aortic dissection after thoracic endovascular aortic repair in patients with type B aortic dissection.

BACKGROUND: Retrograde type A dissection (RTAD) is a devastating complication of thoracic endovascular repair (TEVAR) with low incidence but high mortality. The objective of this study is to report the incidence, mortality, potential risk factors, clinical manifestation and diagnostic modalities, and medical and surgical treatments. METHODS: A systematic review and single-arm and two-arm meta-analyses evaluated all published reports of RTAD post-TEVAR through January 2021. All study types were included, except study protocols and animal studies, without time restrictions. Outcomes of interest were procedural data (implanted stent-grafts type, and proximal stent-graft oversizing), the incidence of RTAD, associated mortality rate, clinical manifestations, diagnostic workouts and therapeutic management. RESULTS: RTAD occurred in 285 out of 10,600 patients: an estimated RTAD incidence of 2.3% (95% CI: 1.9-2.8); incidence of early RTAD was approximately 1.8 times higher than late. Wilcoxon signed-rank testing showed that the proportion of RTAD patients with acute type B aortic dissection (TBAD) was significantly higher than those with chronic TBAD (P = .008). Pooled meta-analysis showed that the incidence of RTAD with proximal bare stent TEVAR was 2.1-fold higher than with non-bare stents: risk ratio was 1.55 (95% CI: 0.87-2.75; P = .13). Single arm meta-analysis estimated a mortality rate of 42.2% (95% CI: 32.5-51.8), with an I2 heterogeneity of 70.11% (P < .001). CONCLUSION: RTAD is rare after TEVAR but with high mortality, especially in the first month post-TEVAR with acute TBAD patients at greater risk as well as those treated with proximal bare stent endografts.

Prognostic factors for long-term survival following complete resection by lobectomy in stage I non-small cell lung cancer.

BACKGROUND: The aim of this study was to evaluate predictors for long-term overall survival (OS) in patients with stage I non-small cell lung cancer (NSCLC). METHODS: All patients undergoing complete resection by lobectomy for stage I NSCLC between October 2012 and December 2015 at a single center were included. Univariable and multivariable Cox regression analyses were performed to identify prognostic factors. RESULTS: A total of 92 patients were included. Univariable and multivariable Cox regression analyses revealed preoperative neutrophil to lymphocyte ratio (NLR, p = 0.005), preoperative diffusion capacity of the lungs for carbon monoxide (DLCO, p = 0.010) and forced expiratory volume in 1 second (FEV1, p = 0.041) as well as male gender (p = 0.026) as independent prognostic factors for OS. Combining the calculated cutoff values for FEV1 (<73.0%) and NLR (>3.49) into one parameter resulted in a highly significant difference in survival times when stratified by this variable. CONCLUSIONS: Recently, much emphasis has been put on the prognostic importance of blood biomarkers in NSCLC. In our study, NLR was an independent factor for OS, as were baseline characteristics such as DLCO, FEV1, and gender. Further studies on the association of biomarkers for systemic inflammation and lung function parameters with respect to patient survival are warranted.

Are Routine Chest X-rays Necessary following Thoracic Surgery? A Systematic Literature Review and Meta-Analysis.

(1) Background: The number of chest X-rays that are performed in the perioperative window of thoracic surgery varies. Many clinics X-ray patients daily, while others only perform X-rays if there are clinical concerns. The purpose of this study was to assess the evidence of perioperative X-rays following thoracic surgery and estimate the clinical value with regard to changes in patient care. (2) Methods: A systematic literature research was conducted up until November 2021. Studies reporting X-ray outcomes in adult patients undergoing general thoracic surgery were included. (3) Results: In total, 11 studies (3841 patients/4784 X-rays) were included. The X-ray resulted in changes in patient care in 488 cases (10.74%). In patients undergoing mediastinoscopic lymphadenectomy or thoracoscopic sympathectomy, postoperative X-ray never led to changes in patient care. (4) Conclusions: There are no data to recommend an X-ray before surgery or to recommend daily X-rays. X-rays immediately after surgery seem to rarely have any consequences. It is probably reasonable to keep requesting X-rays after drain removal since they serve multiple purposes and alter patient care in 7.30% of the cases.

Open redo thymectomy for a large recurrent thymoma in a patient with myasthenia gravis: a case report.

Thoracoscopic and robotic approaches are becoming increasingly popular for thymoma surgery. Yet open thymectomy must still be mastered today, as it may be the only viable option in challenging cases. In this study, we report a case of an extended local recurrence of myasthenia gravis associated thymoma and a history of previous sternotomy. The mediastinal mass infiltrated the left upper lobe of the lung, the pericardium, and presumably the aortic arch. Although the standard for thymoma resection at our institution is the robotic approach, we performed primary open redo thymectomy in standby of cardiopulmonary bypass in this case. Intraoperatively, bleeding from the aortic arch occurred, which was promptly controlled due to the open approach and due to immediate availability of cardiopulmonary bypass. The patient was transferred to the normal ward on the first postoperative day, was treated according to fast-track principles and recovered well. The pathology revealed a WHO B2:B1 thymoma with negative resection margins. Thymectomy is recommended as the principal treatment for thymoma and is also advised in the case of recurrence. However, there is no evidence regarding the optimal surgical approach. Our case indicates that in the era of minimally invasive thymectomy, the decision to conduct open surgery is wise when the risk of serious bleeding is anticipated or adherence to oncologic principles is challenged by tumor size or growth pattern.

A simple size-tailored algorithm for the removal of chest drain following minimally invasive lobectomy: a prospective randomized study.

BACKGROUND: The pleural space can resorb 0.11-0.36 ml/kg of body weight/hour (h) per hemithorax. There are only a limited number of studies on thresholds for chest drain removal (CDR) and all are based on arbitrary amounts, for example, 300 ml/day. We studied an individualized size-based threshold for CDR-specifically 5 ml/kg, a simple, easily applicable measure. METHODS: This is a single-center prospective randomized trial enrolling 80 patients undergoing VATS lobectomy. There were two groups: an experimental (E) group, in which once the daily output went down to 5 ml/kg the chest drain was removed and a control (C) group, with chest drain removal as per our current practice of less than 250 ml/day. RESULTS: The groups did not differ in pre- and peri- and postoperative characteristics, except for chest drain duration (mean, SD 2.02 ± 0.97 vs. 3.25 ± 1.39 days, p < 0.001) and length of hospital stay (median, IQR 4.5; 3 vs. 6; 2.75 days, p = 0.008) in favor of E group. The re-intervention rate was the same in both groups (once in each group). CONCLUSION: The new threshold for chest drain removal following thoracoscopic lobectomy of 5 ml/kg/d leads to both shorter chest drainage and hospital stay without apparent increase in morbidity. (Clinical registration number: DRKS00014252).

Risk factors for surgical complications after anatomic lung resections in the era of VATS and ERAS.

BACKGROUND: The aim of this study was to identify risk factors for surgical complications after anatomic lung resections in the era of video-assisted thoracic surgery (VATS) and enhanced recovery after surgery (ERAS). METHODS: A retrospective analysis of all consecutive adult patients who underwent elective anatomic lung resections between January and December 2020 at our institution was performed. RESULTS: Eighty patients (40 VATS, 40 thoracotomy) were included. The 30-day mortality rate was 1.3%. The overall rate of major postoperative complications was 18.8%. Most major complications occurred in patients who underwent open surgery (complication rate 32.5%, share of total complications 86.7%). Major morbidity after VATS resection was rare (complication rate 2.5%, share of total complications 13.3%). In univariable analysis, thoracotomy (p = 0.003), impaired preoperative lung function (p = 0.003), complex surgery (p = 0.004) and sleeve resection (p = 0.037) were associated with adverse outcomes. In multivariable analysis, thoracotomy (p = 0.044) and impaired preoperative lung function (p = 0.028) were the only independent risk factors for major postoperative morbidity. CONCLUSION: Thoracotomy was associated with a 10-fold increased risk for postoperative complications compared with minimally invasive surgery and was an independent risk factor for surgical complications. In the era of VATS and ERAS, the fact that thoracotomy is performed may be a reliable parameter to identify patients at risk for postoperative complications.

Autologous blood pleurodesis for the treatment of postoperative air leaks. A systematic review and meta-analysis.

BACKGROUND: Postoperative air leaks are a common complication after lung surgery. They are associated with prolonged hospital stay, increased postoperative pain and treatment costs. The treatment of prolonged air leaks remains controversial. Several treatments have been proposed including different types of sealants, chemical pleurodesis, or early surgical intervention. The aim of this review was to analyze the impact of autologous blood pleurodesis in a systematic way. METHODS: A systematic review of the literature was conducted until July 2020. Studies with more than five adult patients undergoing lung resections were included. Studies in patients receiving blood pleurodesis for pneumothorax were excluded. The search strategy included proper combinations of the MeSH terms "air leak", "blood transfusion" and "lung surgery". RESULTS: Ten studies with a total of 198 patients were included in the analysis. The pooled success rate for sealing the air leak within 48 h of the blood pleurodesis was 83.7% (95% CI: 75.7; 90.3). The pooled incidence of the post-interventional empyema was 1.5%, with a pooled incidence of post-interventional fever of 8.6%. CONCLUSIONS: Current evidence supports the idea that autologous blood pleurodesis leads to a faster healing of postoperative air leaks than conservative treatment. The complication rate is very low. Formal recommendations on how to perform the procedure are not possible with the current evidence. A randomized controlled trial in the modern era is necessary to confirm the benefits.

Pulmonary metastasectomy in soft tissue sarcomas: a systematic review.

BACKGROUND: Soft tissue sarcoma (STS) tend to metastasis to the lungs. Pulmonary metastasectomy seems to be a common practice always when plausible. The objective of this article was to review systematically the results of a literature search on pulmonary metastasectomy for STSs published in the last ten years and to offer a brief overview about the current practice as well. METHODS: Eight retrospective studies published in the period 2010-2020, which included patients with pulmonary metastases and metastasectomy were selected. Indication for surgery, survival rate and factors influencing survival were the primary outcomes, while further interesting findings in the studies were also collected and evaluated. RESULTS: Cumulative 1,004 patients participated in these studies. The most common histological types were leiomyosarcoma, malignant fibrous histiocytoma (MFH) and synovial sarcoma, being present together at 60% of the study population. Five-year survival was reported to be in the range from 20-58%, better survival going along with a fewer (preferably one) metastases, longer disease free interval (DFI) and R0 resection in most of the cases. CONCLUSIONS: Complete resection of the metastatic lesions seems to be the most effective treatment for long-term survival, or even achieving cure in selected patients. At selection of the patients amenable for surgery, a high probability of R0 resection, as well as a disease free period of at least 12 months should perhaps bear a higher specific value.

New method in treatment of post-operative air leakage with fresh frozen plasma.

BACKGROUND: No consensus regarding the best post-operative treatment option for air leak has been established. In this study, we evaluate the use of intra-pleural fresh frozen plasma (FFP) as a promising treatment method. METHODS: Treatment for a sustained air leak (3 days) was warranted in approximately 12% of the lung surgeries at our institution. Fifty-two patients were treated with FFP by application of 250 mL daily. The patients were divided into two cohorts: cohort 1 consisted of 35 patients undergoing anatomical lung resections and cohort 2 consisted of 17 patients after miscellaneous types of lung surgery. Successfulness of the procedure as well as the potential influential factors was evaluated statistically and validated by a bootstrapping. Area under receiver operating characteristic curve was used to establish a cut-off value of the predictor. RESULTS: In the first cohort, air leakage was successfully treated in 28 (80%), while in seven (20%) it was still present after third treatment with FFP. The success rate in cohort 2 was 76.5%. The only covariate which appeared to remain significant in both cohorts was flow as displayed on the digital suction device prior to application of FFP. Flow ≤375 mL/min was indicative of successful aerostasis. CONCLUSION: Intra-pleural instillation of FFP seems to be a feasible method for the treatment of post-operative air leakage. Although the optimum strategy regarding its application as well as its limitations is yet to be established, an absence of complications or undesirable events makes this (off label) method a safe and promising alternative to existing options.

Variations in pulmonary fissural anatomy: a medicolegal autopsy study of 256 cases.

BACKGROUND: We aimed to document the anatomical variations of pulmonary fissures found during routine forensic autopsies. METHODS: A total of 256 pairs of lungs were investigated. Presence of any variant and accessory fissures was noted. RESULTS: Seventy-seven percent of the lungs had anatomical variations. In about 2/3 of the cases, oblique fissures were incomplete on both sides. The horizontal fissure was incomplete in 68.4%, and absent in 4.3% of the lungs. Twelve left lungs (4.7%) had a horizontal fissure. Accessory fissures were observed in 35 lungs (13.7%). Azygos lobe variations were detected in 1.7% of the lungs. A superior accessory fissure was present in 6.2% and 2% of right and left lungs, respectively. CONCLUSION: This and previous similar studies demonstrate the existence of several different anatomical fissural variations in the lungs. Clinicians, radiologists and surgeons should keep these in mind to better evaluate and treat their patients.

Cumulative Sum Analysis of the Learning Curve for Uniportal Video-Assisted Thoracoscopic Lobectomy and Lymphadenectomy.

Purpose: The study was performed to analyze the learning curve of performing uniportal video-assisted thoracoscopic surgery (uVATS) for lobectomy and lymphadenectomy, and to evaluate the possible disadvantages in outcomes during the course of learning. Materials and Methods: This is a prospective study of 52 consecutive patients undergoing uVATS lobectomy by a single surgeon from January 2016 to December 2017. Operation time (OPT) and the number of harvested lymph nodes (LNs) were evaluated by means of cumulative sum control chart by assessing efficiency (refinement in procedure to reach decreasing OPT and increasing number of harvested LNs) and mastery (absence of outliers). Failure rate, blood loss, and complications were retrospectively compared with the last 52 patients undergoing "classical" VATS lobectomy in the period before this study from January 2014 to December 2015. Results: Efficiency in OPT for uVATS was reached after 27 cases and mastery after 39 procedures (M1st = 172 ± 39 minutes; M2nd = 138 ± 34 minutes; p1-2 = 0.022; M3rd = 120 ± 25 minutes; p1-3 = 0.00; p2-3 = 0.65). Efficacy in the number of harvested LNs was reached after 26 cases and mastery after the 42nd procedure (MED1st = 17, IQR 12-19; M2nd = 21, IQR 16.25-29.75; p1-2 = 0.018; M3rd = 18, IQR 16-22; p1-3 = 0.004; p2-3 = 0.8). There were no significant differences in the failure rate (uVATS = 7.7%, VATS = 5.8%; P = .7), blood loss (MEDuVATS = 250 mL, IQR 200-387.5; MEDVATS = 225 mL, IQR 200-300; P = .77), and complications between the groups (uVATS = 13; 25%; VATS = 11; 21.2%; P = .41). Finally no significant differences could be found in OPT (uVATS = 151.36 ± 41.55; VATS = 156.69 ± 40.08; P = .52) or LNs (uVATS = 18, IQR 16-22; VATS = 19, IQR 14.25-20; P = .71) between the groups. Conclusions: Assuming a surgeon is skilled in "classic" VATS lung resections, achieving efficiency and mastery in uVATS is possible after sufficient experience even without dedicated education in this procedure, without measurable disadvantages throughout the course of learning. This study created a benchmark for already experienced VATS surgeons who are novices in uVATS, elucidating the number of operations required to reach both efficiency and mastery.

Endobronchial coils in treatment of advanced emphysema: A single center experience.

BACKGROUND: This study aims to present our experience with endobronchial coils in patients who underwent endobronchial lung volume reduction due to advanced emphysema. METHODS: The study included 46 patients (45 males, 1 female; mean age 61.7±8 years; range, 43 to 80 years) who underwent endobronchial lung volume reduction with endobronchial coils for advanced emphysema. Patients" age, gender, pulmonary function tests, post-treatment morbidity, mortality, pre- and post-treatment (6 months) six-minute walking distance, modified Medical Research Council dyspnea scores, chronic obstructive pulmonary disease assessment test and Hospital Anxiety and Depression Scale scores were recorded. RESULTS: Patients had an average of 65 pack/year smoking history. An average of 11 (range, 9-15) coils were placed per lobe (right upper lobe=35, left upper lobe=19, right lower lobe=2, left lower lobe=4). Mean follow-up duration was 12.6 months (±5.6 months). Post-treatment forced expiratory volume in one second, residual volume and six-minute walking distance values were improved with statistical significance. Also, significant improvement was seen in quality of life, quantified by modified Medical Research Council, chronic obstructive pulmonary disease assessment test and Hospital Anxiety and Depression Scale scores. While no immediate major postoperative complications occurred, three patients developed chronic obstructive pulmonary disease exacerbation, two developed pneumonia, and one developed recurrence of previous neurologic disorder within 30 days. CONCLUSION: Endobronchial coil administration provides lower morbidity and mortality compared to lung volume reduction surgery as well as significant improvement in pulmonary functions and quality of life in selected patients with advanced emphysema.

Aspirin for patients undergoing major lung resections: hazardous or harmless?†.

OBJECTIVES: Acetylsalicylic acid (ASA, aspirin) is a medication widely used for primary and secondary prevention of cardiovascular diseases, which are the leading cause of morbidity and mortality worldwide. Whether aspirin should be continued or paused in the perioperative period remains controversial, especially in thoracic surgical settings. METHODS: A single-centred retrospective study comprised 486 patients. Of these, 329 patients did not use aspirin (group ASA-0) and 157 did (group ASA-1) during the perioperative period after anatomical lung resection at our hospital from January 2013 to December 2016. Major outcome measures were the amount of blood loss during the operation and during the first 5 days postoperatively (per Mercuriali's formula), as well as the amount and proportion of the blood transfusion (packed red cells) received. The need for reoperation due to a postoperative haemothorax and/or bleeding was recorded. The groups were also compared according to their rates of morbidity and mortality. Inferential statistical methods with bootstrap analysis using 1000 samples and the Mersenne Twister, a random number generator, were used. RESULTS: There were no significant differences between the 2 groups in intraoperative bleeding [ASA-0M = 418.69 ml, standard deviation (SD) ± 364.87; ASA-1M = 399.8 ml, SD ± 323.84; P = 0.58] or in total blood loss according to Mercuriali's formula (ASA-0M = 1111.62 ml, SD ± 816.69; ASA-1M = 1115.08 ml, SD ± 682.12; P = 0.95). A total of 104 patients received transfusions up to postoperative day 5: 71 patients in the ASA-0 group received 151 blood transfusions, whereas 33 patients in the ASA-1 group received 65 blood transfusions (P = 0.66). The indication for reoperation due to bleeding (ASA-1 = 3, ASA-0 = 4; P = 0.69) was similar between the groups. There was a trend towards higher rates of postoperative complications in the ASA-1 group (risk ratio (RR) = 1.28; P = 0.055); neither cardiovascular complications nor deaths were more frequent in either of the 2 groups (P = 0.73). CONCLUSIONS: Patients taking aspirin therapy and undergoing anatomical lung resection seem not to be at any disadvantage regarding bleeding. However, a trend towards a higher rate of postoperative complications indicates a basically increased risk for operations due to comorbidities in these patients.

Surgery for lung tumors in the elderly: A retrospective cohort study on the influence of advanced age (over 80 years) on the development of complications by using a multivariate risk model.

BACKGROUND: The prevalence of lung cancer and other tumors is increasing among the elderly people. The purpose of this study was to examine the influence of advanced age (80 + years) on the immediate perioperative outcome as well as to define potential risk factors that may lead to increasing morbidity and mortality after lung resections. METHODS: A retrospective cohort analysis of the data from an electronic database of 208 elderly patients (165 patients ≥70 years, 45 patients ≥80 years) undergoing pulmonary anatomical resection for lung tumors during January 2013-December 2016 was conducted. The patients were initially observed and then divided into two groups: septuagenarians and octogenarians. The risk of developing postoperative complications in association with the numerous observed factors, which appeared significant in univariate tests, was assessed using univariate and multivariate logistic regression analyses to construct a risk model that assesses the highest chance of developing complications. Readmission rate and mortality within 90 days were recorded. RESULTS: There were 140 men and 68 women with the mean age of 76 ±â€¯4 years. A total of 15 pneumonectomies (7.2%), 11 bilobectomies (5.3%), 27 segmentectomies (13%), and 155 lobectomies (74.5%) were performed through 84 thoracotomies (40.4%) and 124 video-assisted thoracoscopic surgery (VATS) procedures (59.6%). Ninety-one patients (44%) exhibited at least one of 113 postoperative complications. There were four deaths (1.9%). Readmission rate was 12%, and 90-day mortality was 5.3%. There was no difference in postoperative morbidity among the groups according to their age (RR = 0.95; p = 78). According to multivariate logistic regression, adjusted Charlson Comorbidity Index≥11, FEV1≤0.72, DLCO≤0.57, male gender, and nonsegmentectomies appeared to be strong predictors for the development of complications. CONCLUSIONS: In this cohort, age more than 80 years was not found to be significant for the development of complications, when compared to the septuagenarians. Female gender, better lung function (FEV1>72%, DLCO>57%), less comorbidities (ACCI<11), and segmentectomy type of lung resection were associated with improved outcomes.