Objective

Adoption of thoracoscopic lobectomy has been increasing in the US; however, open lobectomy (OL) is still performed in half of the cases. Postoperative care and enhanced recovery after surgery (ERAS) pathways have evolved and improved outcomes. The study aims to evaluate postoperative outcomes of OL over the last 15 years.

Methods

Patients who underwent lobectomy for lung cancer between 2005 and 2019 were identified in the National Surgical Quality Improvement Program and divided into three groups; pre-ERAS (2005–2011), transitional period (2012–2015), and wider ERAS implementation (2016–2019). Preoperative characteristics and postoperative outcomes were compared and multivariable regression analysis was constructed to assess independent predictors of outcomes.

Results

OL was comprised of 40% of lobectomies for lung cancer. 10,021 patients met inclusion criteria. 49% were males and mean age was 67. Patients who belonged to the (2016–2019) period group had significantly higher comorbidities and ASA classification. General surgeons performed < 10% of OL in 2016–2019 compared to over 30% during 2005–2011. Patients in the 2016–2019 period were less likely to experience unplanned intubation, surgical site infections, and sepsis. Mortality was also significantly lower than the previous groups (1.9% vs 2.0% and 2.8%, p = 0.05). The rate of discharge to facility as well as length of hospital stays improved over the years. The surgeon specialty served as an independent predictor for length of stay, unplanned intubation, and home discharge.

Conclusion

The outcomes of OL are improving over the years. Increasing number of these surgeries being performed by dedicated thoracic surgeons and ERAS pathways are likely helping improve outcomes.

中文翻译：

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过去 15 年肺癌开放肺叶切除术结局的趋势：国家队列

客观的

在美国，胸腔镜肺叶切除术的采用率一直在增加；然而，半数病例仍进行开放性肺叶切除术 (OL)。术后护理和促进术后恢复 (ERAS) 途径已经发展并改善了结果。该研究旨在评估过去 15 年 OL 的术后结果。

方法

2005 年至 2019 年间因肺癌接受肺叶切除术的患者被纳入国家手术质量改进计划，并分为三组；ERAS 之前（2005-2011 年）、过渡期（2012-2015 年）和更广泛的 ERAS 实施（2016-2019 年）。比较术前特征和术后结果，并构建多变量回归分析以评估结果的独立预测因素。

结果

OL 包括 40% 的肺癌肺叶切除术。10,021 名患者符合纳入标准。49% 为男性，平均年龄为 67 岁。属于（2016-2019）期间组的患者合并症和 ASA 分类明显更高。普通外科医生在 2016-2019 年完成的 OL 少于 10%，而在 2005-2011 年这一比例超过 30%。2016-2019 年期间的患者发生意外插管、手术部位感染和败血症的可能性较小。死亡率也显着低于前几组（1.9% vs 2.0% 和 2.8%，p = 0.05）。多年来，出院率和住院时间有所改善。外科医生专业是住院时间、计划外插管和出院的独立预测因素。

结论

多年来，OL 的结果正在改善。越来越多的此类手术由专门的胸外科医生和 ERAS 途径进行，这可能有助于改善结果。