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Objectives: The objective of this investigation was to assess satisfaction with care of patients with long hospital stay (LHS) or complications after pulmonary resection in comparison with case-matched counterparts with a regular postoperative course., Methods: This is a prospective observational analysis on 171 consecutive patients submitted to pulmonary resections (78 wedges, 8 segmentectomies, 83 lobectomies, 3 pneumonectomies) for benign (35), primary (93) or secondary malignant (43) diseases. A hospital stay >7 days was defined as long (LHS). Major cardiopulmonary complications were defined according to the ESTS database. Patient satisfaction was assessed by the administration of the EORTC IN-PATSAT32 module at discharge. The questionnaire is a 32-item self-administered survey including different scales, reflecting the perceived level of satisfaction about the care provided by doctors, nurses and other personnel. To minimize selection bias, propensity score case-matching technique was applied to generate two sets of matched patients: patients with LHS with counterparts without it; patients with complications with counterparts without it., Results: Median length of postoperative stay was 4 days (range 2-43). Forty-one patients (24%) had a hospital stay>7 days and 21 developed cardiopulmonary complications (12%). Propensity score yielded two well-matched groups of 41 patients with and without LHS. There were no significant differences in any patient satisfaction scale between the two groups. The comparison of the results of the patient satisfaction questionnaire between the two matched groups of 21 patients with and without complications did not show significant differences in any scale., Conclusions: Patients experiencing poor outcomes such as long hospital stay or complications have similar perception of quality of care compared with those with regular outcomes. Patient-reported outcome measures are becoming increasingly important in the evaluation of the quality of care and may complement more traditional objective indicators such as morbidity or length of stay., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

The objective of this study was to assess the residual quality of life (QoL) in elderly patients submitted to major lung resection for lung cancer. From July 2004 through August 2007 a total of 218 patients, 85 of whom were elderly (70 years), had complete preoperative and postoperative (3 months) quality of life measures assessed by the Short Form 36v2 health survey. QoL scales were compared between elderly and younger patients. Furthermore, limited to the elderly group, we compared the preoperative with the postoperative SF36v2 measures and the physical component summary (PCS) and mental component summary (MCS) scores between high-risk patients and low-risk counterparts. The postoperative SF36 PCS (50.3 vs. 50, P=0.7) and MCS (50.6 vs. 49, P=0.2) and all SF36 domains did not differ between elderly and younger patients. Within the elderly, the QoL returns to the preoperative values three months after the operation. Moreover, we did not find any significant differences between elderly higher-risk patients and their lower-risk counterparts postoperatively. The information that residual QoL in elderly patients will be similar to the one experienced by younger and fitter individuals may help them in their decision to proceed with surgery.

We report a case of bilateral staged uniportal video-assisted thoracic surgery (VATS) pulmonary resections for synchronous early stage squamous cell carcinoma in a patient with limited respiratory reserve. Wide wedge resections and lymph nodes sampling were performed. Postoperative respiratory function and pain scores were unaffected by the bilateral operations. Uniportal VATS proved to be a feasible alternative to more traditional procedures (three portal VATS or minithoracotomy) in case lesser resections are required for compromised respiratory function and may contribute to increase operability in high-risk patients.

This work was aimed at developing risk-adjusted outcome models for profiling the internal quality of care after major lung resection. One thousand and sixty-two patients submitted to lobectomy (845) or pneumonectomy (217) from 1994 through 2004 at our unit were analyzed. Risk-adjusted models of 30-day or in-hospital morbidity, mortality and failure-to-rescue (death/complication ratio) were developed by stepwise logistic regression analyses and validated by bootstrap procedures. The regression equations were then used to estimate the outcome risks in 3 successive periods of activity (early: 1994-1997; intermediate: 1998-June/2001; late: July/2001-2004). Observed and predicted morbidity, mortality and failure-to-rescue rates were compared within each period by the z-test. The following regression models were developed: Predicted morbidity: ln R/1-R=-2.1+0.035 x age-0.02 x FVC+0.6 x extended resection+0.7 x cardiac co-morbidity (c-index=0.68). Predicted mortality: ln R/1-R=-7.6+0.08 x age-0.04 x ppoFEV1+1.6 x extended resection+1.2 x cardiac co-morbidity+1.1 x cerebrovascular co-morbidity (c-index=0.83). Predicted failure-to-rescue: ln R/1-R=-6.7+0.06 x age+1.5 x extended resection+1.2 x cerebrovascular co-morbidity (c-index=0.71). No differences were noted between observed and predicted outcome rates within each period, despite apparent unadjusted differences between periods. The use of risk-adjusted outcome models prevented misleading information derived from the unadjusted analysis of performance. We are currently using these models for internal quality-of-care audit purposes.

The study was aimed at assessing the influence of the elective ICU admission on the early outcome after major lung resection by analyzing the different postoperative management policies of two centers. Center A managed all patients in a dedicated ward, resorting to ICU for complications requiring invasive assisted ventilation. In center B, high-risk patients were electively transferred to ICU immediately after operation. Propensity score was used to match those patients of center B electively admitted to ICU (96 of 157), with counterparts from center A (96 of 205). The outcome of these matched pairs were then compared. There was a trend of reduced total morbidity (23% vs. 35%, respectively; P=0.06), cardiovascular (13.5% vs. 23%, respectively; P=0.09) and pulmonary complication rates (9.3% vs. 18%, respectively; P=0.09), but a longer postoperative hospital stay (11.5 vs. 9.7, respectively; P=0.015) in the patients electively admitted to ICU, compared to matched center A patients. Mortality rates were not different (7.3% vs. 7.3%; P=1). Since the elective postoperative ICU admission did not show a clear-cut outcome benefit over the management in a dedicated ward, this practice should be limited to highly selected patients in order to efficiently utilize the available resources.

The objective of the study was to develop regression models for the prediction of the decline of the forced expiratory volume in one second (FEV1) and the carbon monoxide lung diffusion capacity (DLCO) early after major lung resection. One hundred and ninety patients submitted to pulmonary lobectomy or pneumonectomy for lung cancer performed preoperative and early postoperative (mean 10.9 after operation) pulmonary function tests. One hundred and fifty of these patients also underwent DLCO measurements by the single breath method. The decline of FEV1 and DLCO were expressed as percentage losses from preoperative values. Stepwise multiple regression analyses were performed to develop two models estimating the percent reduction of FEV1 and DLCO from preoperative values. The multivariate procedures were then validated by bootstrap analyses. The following regression equations were derived: estimated percent reduction in FEV1 = 21.34 - (0.47 x age) + (0.49 x percentage of functioning parenchyma removed during operation) + (17.91 x COPD-index); estimated percent reduction in DLCO = 35.99 - (0.31 x age) - (36.47 x FEV1/FVC ratio) + (0.33 x DLCO) + (0.54 x percentage of functioning parenchyma removed during operation). The comparison between observed and estimated losses of FEV1 and DLCO (by using these regression equations) was not significantly different. We think the regression models generated in this study may be reliably used for risk stratification purposes.