JTCVS Open (Dec 2023)

Determining the optimal time to report mortality after lobectomy for lung cancer: An analysis of the time-varying risk of deathCentral MessagePerspective

  • Matthew Shiu Hang Wong,
  • Aina Pons, BSc, PGCert,
  • Paulo De Sousa, BSc, PgDip, RGN,
  • Chiara Proli, MD,
  • Simon Jordan, MB BCh, MD, FRCS,
  • Sofina Begum, MB ChB, MSc, FRCS,
  • Silviu Buderi, MB BCh, MSc, FRCSEd,
  • Vladimir Anikin, MD, FRCS,
  • Jonathan Finch, MBBS, FRCS,
  • Nizar Asadi, MD, FRCS,
  • Emma Beddow, MBBS, FRCS,
  • Eric Lim, MB ChB, MD, MSc, FRCS

Journal volume & issue
Vol. 16
pp. 931 – 937

Abstract

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Objective: Surgical mortality has traditionally been assessed at arbitrary intervals out to 1 year, without an agreed optimum time point. The aim of our study was to investigate the time-varying risk of death after lobectomy to determine the optimum period to evaluate surgical mortality rate after lobectomy for lung cancer. Methods: We performed a retrospective study of patients undergoing lobectomy for lung cancer at our institution from 2015 to 2022. Parametric survival models were assessed and compared with a nonparametric kernel estimate. The hazard function was plotted over time according to the best-fit statistical distribution. The time points at which instantaneous hazard rate peaked and stabilized in the 1-year period after surgery were then determined. Results: During the study period, 2284 patients underwent lobectomy for lung cancer. Cumulative mortality at 30, 90, and 180 days was 1.3%, 2.9%, and 4.9%, respectively. Log-logistic distribution showed the best fit compared with other statistical distribution, indicated by the lowest Akaike information criteria value. The instantaneous hazard rate was greatest during the immediate postoperative period (0.129; 95% confidence interval, 0.087-0.183) and diminishes rapidly within the first 30 days after surgery. Instantaneous hazard rate continued to decrease past 90 days and stabilized only at approximately 180 days. Conclusions: In-hospital mortality is the optimal follow-up period that captures the early-phase hazard during the immediate postoperative period after lobectomy. Thirty-day mortality is not synonymous to “early mortality,” as instantaneous hazard rate remains elevated well past the 90-day time point and only stabilizes at approximately 180 days after lobectomy.

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