Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA.
Eur J Cardiothorac Surg. 2011 Jul;40(1):83-90. doi: 10.1016/j.ejcts.2010.11.023. Epub 2010 Dec 18.
The effect of seasonal variation on postoperative outcomes following lung cancer resections is unknown. We hypothesized that postoperative outcomes following surgical resection for lung cancer within the United States would not be impacted by operative season.
From 2002 to 2007, 182507 isolated lung cancer resections (lobectomy (n = 147 937), sublobar resection (n = 21650), and pneumonectomy (n = 13916)) were evaluated using the Nationwide Inpatient Sample (NIS) database. Patients were stratified according to operative season: spring (n = 47382), summer (n = 46131), fall (n = 45370) and winter (n = 43624). Multivariate regression models were applied to assess the effect of operative season on adjusted postoperative outcomes.
Patient co-morbidities and risk factors were similar despite the operative season. Lobectomy was the most common operation performed: spring (80.0%), summer (81.3%), fall (81.8%), and winter (81.1%). Lung cancer resections were more commonly performed at large, high-volume (>75th percentile operative volume) centers (P < 0.001). Unadjusted mortality was lowest during the spring (2.6%, P < 0.001) season compared with summer (3.1%), fall (3.0%) and winter (3.2%), while complications were most common in the fall (31.7%, P < 0.001). Hospital length of stay was longest for operations performed in the winter season (8.92 ± 0.11 days, P < 0.001). Importantly, multivariable logistic regression revealed that operative season was an independent predictor of in-hospital mortality (P < 0.001) and of postoperative complications (P < 0.001). Risk-adjusted odds of in-hospital mortality were increased for lung cancer resections occurring during all other seasons compared with those occurring in the spring.
Outcomes following surgical resection for lung cancer are independently influenced by time of year. Risk-adjusted in-hospital mortality and hospital length of stay were lowest during the spring season.
术后结局受季节变化影响的情况在肺癌手术后并不明确。我们推测，美国的肺癌手术后的结局不会受到手术季节的影响。
2002 年至 2007 年间，使用全国住院患者样本数据库（NIS）评估了 182507 例孤立性肺癌切除术（肺叶切除术（n = 147937）、亚肺叶切除术（n = 21650）和全肺切除术（n = 13916））。患者根据手术季节分层：春季（n = 47382）、夏季（n = 46131）、秋季（n = 45370）和冬季（n = 43624）。应用多变量回归模型评估手术季节对术后结局的影响。
尽管手术季节不同，但患者的合并症和危险因素相似。肺叶切除术是最常见的手术：春季（80.0%）、夏季（81.3%）、秋季（81.8%）和冬季（81.1%）。肺切除术更多地在大型、高容量（>第 75 个百分位手术量）中心进行（P < 0.001）。未调整的死亡率在春季最低（2.6%，P < 0.001），其次是夏季（3.1%）、秋季（3.0%）和冬季（3.2%），而并发症在秋季最常见（31.7%，P < 0.001）。冬季手术的住院时间最长（8.92 ± 0.11 天，P < 0.001）。重要的是，多变量逻辑回归显示，手术季节是院内死亡率（P < 0.001）和术后并发症（P < 0.001）的独立预测因子。与春季相比，其他季节肺癌切除术的院内死亡率风险调整后比值均增加。
肺癌手术后的结局受一年中时间的影响。风险调整后的院内死亡率和住院时间在春季最低。
