Ninety-day mortality following lung cancer surgery: outcomes from the English national clinical outcomes audit
Dr Helen Morgan is lead author of the study. You can read the whole article here. Dr Morgan is the Roy Castle Lung Cancer Foundation Research Fellow.
To produce accurate data tables for 90-day postoperative mortality, which can be used to help explain risk factors when healthcare professionals are discussing treatment options with patients to be used as a communication aid in the consenting process.
Accurate prediction of surgical outcomes is necessary for both determining which people with lung cancer are suitable for surgical intervention, and to help in shared decision making.
Surgical resection offers people with lung cancer the best chance of a curative outcome, but there are risks associated with all surgical procedures. Since healthcare professionals must ensure that patients properly understand these risks before consenting to undergo surgery, they need the most accurate information to help in these discussions.
Most risk-assessment scoring systems currently in use have been found to be insufficiently accurate in assessing surgical outcomes for people with lung cancer. Many of them focus on mortality rates at 30 days after surgery, whereas data research shows that figures for mortality 90 days after surgery is more appropriate and useful with reference to lung cancer.
The study notes that while ‘’90-day mortality is preferred following thoracic surgery for malignancy, it may be impacted by additional factors, such as mortality from postoperative chemotherapy, an therefore, may not reflect only surgical outcomes”.
What is the problem to be addressed?
In her abstract, Dr Helen Morgan writes: ‘’The currently available multivariable mortality prediction tools perform poorly, and could mislead patients. Using data from 2004 to 2012, this [research] group has previously produced data tables for 90-day postoperative mortality, to be used as a communication aid in the consenting process. Using National Lung Cancer Clinical Outcomes audit data from 2017 to 2018, we have produced updated early mortality tables, to reflect current thoracic surgery practice.’’
The research team, centered on Nottingham, generated a previous risk score system which had performed well compared with other existing systems, but which ‘’subsequently failed to meet required levels of accuracy on validation’’. So, they set about creating a better system.
Dr Morgan added: ‘’As an alternative, stratified tables of postoperative mortality were produced, for use when considering individual patient risk by both clinicians and patients. Recently, models of lung cancer surgery have changed in many countries, including decreased pneumonectomies and increasing video-assisted thoracic surgery (VATS), changes which should have increased patient safety. Considering this, we have produced updated mortality tables, to ensure patients are adequately informed of their risk.
The study notes a trend towards better outcomes for people receiving lung cancer surgery.
Compared with outcomes from 2004 to 2012, a 90-day postoperative mortality in 2017–2018 has nearly halved, from 5.9% to 3.1% for the whole cohort. Likewise, mortality in lobectomies continues to improve. The 90-day mortality shows a trend to improvement in all groups since 2004–2012
Findings and outcomes
For people with lung cancer, postoperative mortality continues to improve. The majority of procedures are now completed via VATS, which confers a better 90-day survival compared with open procedures.
In their conclusion, the research team reported ‘’a decrease in 90-day mortality for patients undergoing surgery with curative intent. We also conclude that perioperative mortality from VATS is approximately half that of open procedures, and should be used where clinically appropriate.’’
The study also urges that the new tables ‘’should be used to enhance communication during shared decision making.’’
Publication: Thorax – Ninety-day mortality following lung cancer surgery: outcomes from the English national clinical outcomes audit.
Morgan H, Baldwin D, Hubbard R, et al.
Thorax 2022; 77:724–726
Researchers: Helen Morgan, David Baldwin, Richard Hubbard, Neal Navani, Doug West, Emma Louise O’Dowd
Type of research: patient experience.
The research was funded by the Roy Castle Lung Cancer Foundation.