Predictors of Mortality After Surgical Management of Lung Cancer in the National Cancer Database

Background. Surgical resection represents the standard of care for locoregionally confined non-small cell lung cancer (NSCLC); however, surgical complications may compromise the overall outcome. Adverse events after lung cancer surgery have been studied extensively, yet available databases have significant limitations (with respect to size, provider, patient age, and so forth). The National Cancer Database (NCDB) is the largest cancer registry in the world, capturing 67% of newly diagnosed NSCLC in the United States. We studied surgically managed NSCLC patients in the NCDB to more accurately assess factors that influence perioperative outcomes. Methods. Patients diagnosed with NSCLC from 2004 to 2009 in the NCDB who were managed with surgical resection were included (n = 119,146). Primary endpoints included death within 30 days of surgery and extended length of stay (more than 14 days). Results. Overall 30-day mortality rate was 3.4% and varied by procedure: lobectomy/bilobectomy (2.6%), wedge resection (4.2%), extended lobectomy/bilobectomy (4%), and pneumonectomy (8.5%). By multivariable analysis, increasing age, male sex, increasing comorbidities, and decreased facility volume were associated with higher 30-day mortality. Of patients who underwent lobectomy, 9.1% had an extended length of stay. On multivariable analysis, increasing age, male sex, increasing comorbidities, decreasing facility volume, and right-sided tumors were associated with increased incidence of extended length of stay. Conclusions. Adverse events after the surgical treatment of NSCLC in the NCDB occur with a similar frequency and are predicted by similar patient, procedural, and facility variables as have been identified by more restricted data resources. The NCDB appears to be a valuable resource to study NSCLC in the United States. (C) 2014 by The Society of Thoracic Surgeons