Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERYMONDAY AFTERNOONMAY 11, 20092:00 p.m. SIMULTANEOUS SCIENTIFIC SESSION –GENERAL THORACIC SURGERYRoom 302–306, Hynes Convention Center(8 minutes presentation, 12 minutes discussion)Moderators: James D. LuketichBryan F. Meyers14. Thoracoscopic Lobectomy Is Associated with Lower Morbiditythan Open Lobectomy: A Propensity-Matched Analysis from theSTS DatabaseSubroto Paul, 1† Nasser K. Altorki, 1* Shubin Sheng, 2 Paul C. Lee, 1 David H. Harpole, 2*Mark W. Onaitis, 2 Brendon M. Stiles, 1 Jeffrey L. Port, 1 Thomas A. D’Amico 2*1. Cardiothoracic Surgery, New York, Presbyterian-Weill Cornell Medical Center,New York, NY, USA; 2. Duke University Medical Center, Durham, NC, USAInvited Discussant: Neil A. ChristieMONDAYAfternoonOBJECTIVE: Thoracoscopic lobectomy, compared to thoracotomy, may be associatedwith fewer overall postoperative complications based on several single institutionseries. Propensity matching using a large national database may enable a morepowerful and comprehensive analysis of postoperative outcomes.METHODS: All patients undergoing lobectomy as the primary procedure viathoracoscopy or thoracotomy were identified in the Society of Thoracic Surgeons(STS) prospective database from 2002–2007. After excluding patients with priorthoracic surgery, 6434 patients were identified (5134 thoracotomy, 1300 thoracoscopy).A propensity analysis was performed, incorporating preoperative variablesusing a greedy matching algorithm.RESULTS: Propensity scores were calculated based on age, sex, body mass index,functional status, medical co-morbidities, smoking status, pulmonary functiontests, and preoperative therapy. Matching based on propensity scores produced1281 patients in each group for analysis of postoperative outcomes. After thoracoscopiclobectomy, 73.8% (n = 945) had no complications, compared to only 65.3%(n = 847) after thoracotomy (p < 0.0001). Compared to thoracotomy, thoracoscopiclobectomy was associated with a lower incidence of arrhythmias [93 (7.3%) v 147(11.5%); p = 0.0004], reintubation [18 (1.4%) v 40 (3.1%); p = 0.0046], and bloodtransfusion [31 (2.4%) v 60 (4.68%); p = 0.0028], as well as a shorter length of stay(4.00 v 6.00 days; p < 0.0001) and chest tube duration (3.00 v 4.00 days; p < 0.0001;Table). Thoracoscopic lobectomy required longer operative time (173 v. 143 minutes;p < 0.05). There was no difference in operative mortality between the 2 groups.* AATS Member† Resident Traveling Fellowship 200695