He Xiaoying, Wu Weibin, Wang Yan, Xiao Jingyi, Feng Juanjuan, Hong Hua, Chen Yue, Huang Rong, Guan Hongyu, Li Hai
Health Management Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Clin Med Insights Oncol. 2025 Feb 20;19:11795549251319583. doi: 10.1177/11795549251319583. eCollection 2025.
The clinical impact of heart failure (HF) on postoperative outcomes following video-assisted thoracic surgery (VATS) for lung cancer resection remains controversial. This study aimed to assess patient and hospital characteristics related to the type of surgery, as well as the independent impact of HF on surgical outcomes.
We conducted a retrospective analysis using data from the National Inpatient Sample database. A total of 20 693 patients aged 18 years or older, diagnosed with lung cancer, and undergoing lobectomy or sublobar resection via VATS between 2016 and 2020 were included. Patients were stratified based on the presence of HF. The HF-present cohorts were matched to HF-absent controls using a 1:2 nearest-neighbor propensity score-matching (PSM) analysis. The matched cohorts were then compared across several endpoints, including mortality, length of stay (LOS), hospitalization costs, and postoperative complications.
After PSM, the study included 1781 patients who underwent lobectomy and 1157 who underwent sublobar resection, with 594 and 386 patients, respectively, having concurrent HF. In both the lobectomy and sublobar resection groups, patients with HF demonstrated significantly higher in-hospital mortality rates ( < .001), longer LOS ( < .001), increased total hospital charges ( < .001), and a greater risk for overall postoperative complications ( < .001).
Among patients with lung cancer undergoing VATS, the presence of HF is associated with an increased risk of postoperative complications. This finding underscores the necessity for enhanced monitoring and care for patients with HF should be treated during the postoperative recovery phase.
心力衰竭（HF）对肺癌切除电视辅助胸腔镜手术（VATS）术后结局的临床影响仍存在争议。本研究旨在评估与手术类型相关的患者和医院特征，以及HF对手术结局的独立影响。
我们使用国家住院样本数据库的数据进行了一项回顾性分析。纳入了2016年至2020年间18岁及以上、被诊断为肺癌并通过VATS进行肺叶切除术或肺段切除术的20693例患者。根据是否存在HF对患者进行分层。采用1:2最近邻倾向评分匹配（PSM）分析将存在HF的队列与无HF的对照组进行匹配。然后在包括死亡率、住院时间（LOS）、住院费用和术后并发症在内的几个终点对匹配队列进行比较。
经过PSM后，该研究纳入了1781例行肺叶切除术的患者和1157例行肺段切除术的患者，分别有594例和386例患者并发HF。在肺叶切除术和肺段切除术组中，HF患者的院内死亡率均显著更高（<0.001），LOS更长（<0.001），总住院费用增加（<0.001），术后总体并发症风险更高（<0.001）。
在接受VATS的肺癌患者中，HF的存在与术后并发症风险增加相关。这一发现强调了在术后恢复阶段对HF患者加强监测和护理的必要性。
