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Ann Thorac Surg 1985;40:349-352
© 1985 The Society of Thoracic Surgeons
From the Division of Cardiothoracic Surgery, Department of Surgery, The University of North Carolina School of Medicine, Chapel Hill, NC.
* Address reprint requests to Dr. Keagy, The School of Medicine, 108 Burnett-Womack Bldg 229H, Chapel Hill, NC 27514
Periodic review of clinical results is essential to ensure that high-quality patient care is maintained. To that end, we reviewed the morbidity and operative mortality in a consecutive series of 369 pulmonary lobectomies performed between January 1, 1970, and December 31, 1983. There were 251 male and 118 female patients with a mean age of 50.6 years. The thirty-day operative mortality was 2.2% (8/369), with 6 of these deaths related primarily to respiratory insufficiency. Two hundred twenty-four postoperative management problems occurred in 151 patients and included arrhythmia, air leak, pneumothorax, respiratory difficulties, postoperative bleeding, pleural effusion, wound infection, myocardial infarction, pulmonary embolus, empyema, bronchial stump leak, and lobar gangrene.
Multiple factors were related to the occurrence of post-operative morbidity and mortality using both chi-square analysis to examine each individual item and discriminant analysis to evaluate their interaction. Chi-square tabulation showed no difference in the occurrence of major post-operative complications (p > 0.05) related to the side of operation, an abnormal preoperative electrocardiogram, a forced vital capacity of 2.8 liters or less, a one-second forced expiratory volume (FEV1) of less than 1.7 liters, an oxygen tension of less than 60 mm Hg, or the seniority of the surgeon (resident versus attending). An increased number of complications (p < 0.05) was found in male patients, in patients operated on for carcinoma, and in patients older than 60 years. Stepwise discriminant analysis included FEV1 as a significant predictor of postoperative complications. We conclude that elective lobectomy in a well-supervised residency program can be performed with a low mortality and that modern care techniques bring the vast majority of complications to a successful resolution.
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