The long-term impact of surgical complications after resection of stage i nonsmall cell lung cancer: A population-based survival analysis

Natasha M. Rueth, Helen M. Parsons, Elizabeth B. Habermann, Shawn S. Groth, Beth A. Virnig, Todd M. Tuttle, Rafael S. Andrade, Michael A. Maddaus, Jonathan D'Cunha

Research output: Contribution to journalArticle

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Abstract

Objective: Surgical morbidity may influence long-term cancer survival. Because resection of early stage nonsmall cell lung cancer (NSCLC) is primary therapy, we sought to determine the survival impact of surgical complications for elderly patients undergoing resection of stage I NSCLC. Methods: Using the linked Surveillance Epidemiology and End Results-Medicare database (2000-2005), we identified elderly patients who underwent lobectomy for stage I NSCLC. We then assessed the unadjusted association between in-hospital, postoperative complications, and long-term survival for patients who survived more than 30 days after resection using the Kaplan-Meier method. Finally, we used Cox proportional hazards regression to evaluate the relationship between postoperative complications and 5-year cancer-specific (CSS) and overall survival (OS) after adjusting for patient, tumor, and treatment characteristics. Results: We identified 3996 eligible patients. The overall in-hospital, postoperative complication rate was 54.2%. Pulmonary complications were the most common (n = 1464) followed by cardiac (n = 916). Unadjusted 5-year CSS was significantly worse for those who had an in-hospital, postoperative complication (70.9%) compared to those who did not (78.9%, P < 0.001). OS was also significantly worse (P < 0.001) for patients who developed a complication. Complications continued to predict worse 5-year CSS and OS after adjusting for patient, tumor, and treatment characteristics (HR: 1.38, 95% CI, 1.17-1.64). Conclusions: The occurrence of in-hospital postoperative complications was an independent predictor of worse 5-year CSS after resection of stage I NSCLC. Importantly, the impact of surgical complications extends well after the initial perioperative period. These findings may help identify important targets for best practice guidelines and quality-of-care measures.

Original languageEnglish (US)
Pages (from-to)368-374
Number of pages7
JournalAnnals of Surgery
Volume254
Issue number2
DOIs
StatePublished - Aug 2011
Externally publishedYes

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Survival Analysis
Non-Small Cell Lung Carcinoma
Survival
Population
Practice Guidelines
Neoplasms
Perioperative Period
Quality of Health Care
Medicare
Epidemiology
Therapeutics
Databases
Morbidity
Lung

ASJC Scopus subject areas

  • Surgery

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Rueth, N. M., Parsons, H. M., Habermann, E. B., Groth, S. S., Virnig, B. A., Tuttle, T. M., ... D'Cunha, J. (2011). The long-term impact of surgical complications after resection of stage i nonsmall cell lung cancer: A population-based survival analysis. Annals of Surgery, 254(2), 368-374. https://doi.org/10.1097/SLA.0b013e31822150fe

The long-term impact of surgical complications after resection of stage i nonsmall cell lung cancer : A population-based survival analysis. / Rueth, Natasha M.; Parsons, Helen M.; Habermann, Elizabeth B.; Groth, Shawn S.; Virnig, Beth A.; Tuttle, Todd M.; Andrade, Rafael S.; Maddaus, Michael A.; D'Cunha, Jonathan.

In: Annals of Surgery, Vol. 254, No. 2, 08.2011, p. 368-374.

Research output: Contribution to journalArticle

Rueth, NM, Parsons, HM, Habermann, EB, Groth, SS, Virnig, BA, Tuttle, TM, Andrade, RS, Maddaus, MA & D'Cunha, J 2011, 'The long-term impact of surgical complications after resection of stage i nonsmall cell lung cancer: A population-based survival analysis', Annals of Surgery, vol. 254, no. 2, pp. 368-374. https://doi.org/10.1097/SLA.0b013e31822150fe
Rueth, Natasha M. ; Parsons, Helen M. ; Habermann, Elizabeth B. ; Groth, Shawn S. ; Virnig, Beth A. ; Tuttle, Todd M. ; Andrade, Rafael S. ; Maddaus, Michael A. ; D'Cunha, Jonathan. / The long-term impact of surgical complications after resection of stage i nonsmall cell lung cancer : A population-based survival analysis. In: Annals of Surgery. 2011 ; Vol. 254, No. 2. pp. 368-374.
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abstract = "Objective: Surgical morbidity may influence long-term cancer survival. Because resection of early stage nonsmall cell lung cancer (NSCLC) is primary therapy, we sought to determine the survival impact of surgical complications for elderly patients undergoing resection of stage I NSCLC. Methods: Using the linked Surveillance Epidemiology and End Results-Medicare database (2000-2005), we identified elderly patients who underwent lobectomy for stage I NSCLC. We then assessed the unadjusted association between in-hospital, postoperative complications, and long-term survival for patients who survived more than 30 days after resection using the Kaplan-Meier method. Finally, we used Cox proportional hazards regression to evaluate the relationship between postoperative complications and 5-year cancer-specific (CSS) and overall survival (OS) after adjusting for patient, tumor, and treatment characteristics. Results: We identified 3996 eligible patients. The overall in-hospital, postoperative complication rate was 54.2{\%}. Pulmonary complications were the most common (n = 1464) followed by cardiac (n = 916). Unadjusted 5-year CSS was significantly worse for those who had an in-hospital, postoperative complication (70.9{\%}) compared to those who did not (78.9{\%}, P < 0.001). OS was also significantly worse (P < 0.001) for patients who developed a complication. Complications continued to predict worse 5-year CSS and OS after adjusting for patient, tumor, and treatment characteristics (HR: 1.38, 95{\%} CI, 1.17-1.64). Conclusions: The occurrence of in-hospital postoperative complications was an independent predictor of worse 5-year CSS after resection of stage I NSCLC. Importantly, the impact of surgical complications extends well after the initial perioperative period. These findings may help identify important targets for best practice guidelines and quality-of-care measures.",
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T1 - The long-term impact of surgical complications after resection of stage i nonsmall cell lung cancer

T2 - A population-based survival analysis

AU - Rueth, Natasha M.

AU - Parsons, Helen M.

AU - Habermann, Elizabeth B.

AU - Groth, Shawn S.

AU - Virnig, Beth A.

AU - Tuttle, Todd M.

AU - Andrade, Rafael S.

AU - Maddaus, Michael A.

AU - D'Cunha, Jonathan

PY - 2011/8

Y1 - 2011/8

N2 - Objective: Surgical morbidity may influence long-term cancer survival. Because resection of early stage nonsmall cell lung cancer (NSCLC) is primary therapy, we sought to determine the survival impact of surgical complications for elderly patients undergoing resection of stage I NSCLC. Methods: Using the linked Surveillance Epidemiology and End Results-Medicare database (2000-2005), we identified elderly patients who underwent lobectomy for stage I NSCLC. We then assessed the unadjusted association between in-hospital, postoperative complications, and long-term survival for patients who survived more than 30 days after resection using the Kaplan-Meier method. Finally, we used Cox proportional hazards regression to evaluate the relationship between postoperative complications and 5-year cancer-specific (CSS) and overall survival (OS) after adjusting for patient, tumor, and treatment characteristics. Results: We identified 3996 eligible patients. The overall in-hospital, postoperative complication rate was 54.2%. Pulmonary complications were the most common (n = 1464) followed by cardiac (n = 916). Unadjusted 5-year CSS was significantly worse for those who had an in-hospital, postoperative complication (70.9%) compared to those who did not (78.9%, P < 0.001). OS was also significantly worse (P < 0.001) for patients who developed a complication. Complications continued to predict worse 5-year CSS and OS after adjusting for patient, tumor, and treatment characteristics (HR: 1.38, 95% CI, 1.17-1.64). Conclusions: The occurrence of in-hospital postoperative complications was an independent predictor of worse 5-year CSS after resection of stage I NSCLC. Importantly, the impact of surgical complications extends well after the initial perioperative period. These findings may help identify important targets for best practice guidelines and quality-of-care measures.

AB - Objective: Surgical morbidity may influence long-term cancer survival. Because resection of early stage nonsmall cell lung cancer (NSCLC) is primary therapy, we sought to determine the survival impact of surgical complications for elderly patients undergoing resection of stage I NSCLC. Methods: Using the linked Surveillance Epidemiology and End Results-Medicare database (2000-2005), we identified elderly patients who underwent lobectomy for stage I NSCLC. We then assessed the unadjusted association between in-hospital, postoperative complications, and long-term survival for patients who survived more than 30 days after resection using the Kaplan-Meier method. Finally, we used Cox proportional hazards regression to evaluate the relationship between postoperative complications and 5-year cancer-specific (CSS) and overall survival (OS) after adjusting for patient, tumor, and treatment characteristics. Results: We identified 3996 eligible patients. The overall in-hospital, postoperative complication rate was 54.2%. Pulmonary complications were the most common (n = 1464) followed by cardiac (n = 916). Unadjusted 5-year CSS was significantly worse for those who had an in-hospital, postoperative complication (70.9%) compared to those who did not (78.9%, P < 0.001). OS was also significantly worse (P < 0.001) for patients who developed a complication. Complications continued to predict worse 5-year CSS and OS after adjusting for patient, tumor, and treatment characteristics (HR: 1.38, 95% CI, 1.17-1.64). Conclusions: The occurrence of in-hospital postoperative complications was an independent predictor of worse 5-year CSS after resection of stage I NSCLC. Importantly, the impact of surgical complications extends well after the initial perioperative period. These findings may help identify important targets for best practice guidelines and quality-of-care measures.

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