Most deaths after resection for lung cancer happen post-discharge

Among patients undergoing resection for lung cancer, 50% of deaths occur within 90 days after hospital discharge. And, strikingly, 90-day mortality rates in these patients are twice that of 30-day mortality rates, according to results from a study published in Surgical Oncology.

“Evidence has been consistently provided that 90-day mortality after pulmonary resection for lung cancer can exceed the double of 30-day mortality, with similar mortality rates reported for the first 30 postoperative days and the postoperative period from 31 to 90 days,” noted study researchers, led by Florencio Quero-Valenzuela, MD, Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain.

“An explanation is that deaths that occur beyond 30 postoperative days may not be recorded. Some patients may die more than a month after surgery, as a result of severe postoperative complications that required prolonged hospitalization. On the other hand, death beyond 31 postoperative days may occur during readmission, or suddenly at home from complications. Thus, surgery-related deaths may be underreported when only 30-day mortality is recorded,” they added.

Thus, they conducted this prospective, follow-up study to take a closer look at 90-day mortality rates in 378 patients (83.3% male) who underwent pulmonary resection for lung cancer.

Dr. Quero-Valenzuela and colleagues found that the overall 30-day mortality rate was 1.6% compared with 3.2% for overall 90-day mortality. Both 30- and 90-day mortality rates were highest in patients who underwent pneumonectomy (3.7% and 7.4%, respectively), followed by lobectomy (1.6% and 3.6%).

The mean number of postoperative days until death was 39 days, and the mean age of those who died within the first 90 days after surgery was 67.91 years compared with a mean age of 65.21 years in those who survived (P=0.371). Mean length of hospital stay was greater in patients who died within the first 90 days compared with those who survived (14.7 vs 7.2 days; P=0.002).

Upon univariate analysis, researchers also found significant differences in 30-day mortality in patients with a history of peripheral vascular disease (P=0.033), postoperative pneumonia (P=0.029), postoperative pulmonary/lobar collapse (P=0.031), postoperative arrhythmia (P < 0.001), reintubation (P < 0.001), and in those who underwent a pneumonectomy (P=0.027).

Characteristics that were associated with 90-day mortality included a Charlson index of > 3 (P < 0.001) or a history of stroke (P=0.036). Associated postoperative complications included pneumonia (P=0.001), pulmonary/lobar collapse (P=0.001), reintubation (P < 0.001), and arrhythmia (P=0.002).

All deaths occurred in patients who underwent thoracotomy, which was also associated with 90-day mortality (P=0.011), as was hospital readmission (P < 0.001). Ninety-day mortality was not associated with pneumonectomy compared with lobar and sublobar resection (P=0.1), and there were no differences based on gender, histology, age, respiratory functional FEV1, carbon monoxide diffusing capacity (DLCO), predicted postoperative FEV1, predicted postoperative DLCO, maximal oxygen uptake (VO₂ max), tobacco use, induction or adjuvant cancer treatment, or the presence of diabetes, hypertension, ischemic heart disease, COPD, or obesity.

Pneumothorax and subcutaneous emphysema (30.4%) were the most common reasons for readmission, followed by pneumonia (13%) and pleural empyema (8.7%).

Respiratory and cardiovascular complications were the most common causes of death (58.3% and 33.2%, respectively). Respiratory complications included postoperative pneumonia, bronchial fistula and pleural empyema, and acute pulmonary thromboembolism.

“The findings of this study have direct implications for clinical practice, as they provide more accurate data to healthcare professionals and patients on the risk of mortality following a pulmonary resection for lung cancer beyond the first 30 days. The data obtained could be useful for the design of specific outpatient follow-up programs based on follow-up visits and the optimization of postsurgical care for patients at a higher risk of mortality,” concluded Dr. Quero-Valenzuela et al.