BACKGROUND: The thoracic morbidity and mortality (TM&M) classification system univocally encodes the postoperative adverse events by their management complexity. This study aims to compare the distribution of the severity of complications according to the TM&M system versus the distribution according to the classification proposed by European Society of Thoracic Surgeons (ESTS) Database in a population of patients submitted to video assisted thoracoscopic surgery (VATS) lung resection. METHODS: A total of 227 consecutive patients submitted to VATS lobectomy for lung cancer were analyzed. Any complication developed postoperatively was graded from I to V according to the TM&M system, reflecting the increasing severity of its management. We verified the distribution of the different grades of complications and analyzed their frequency among those defined as "major cardiopulmonary complications" by the ESTS Database. RESULTS: Following the ESTS definitions, 20 were the major cardiopulmonary complications [atrial fibrillation (AF): 10, 50%; adult respiratory distress syndrome (ARDS): 1, 5%; pulmonary embolism: 2, 10%; mechanical ventilation >24 h: 1, 5%; pneumonia: 3, 15%; myocardial infarct: 1, 5%; atelectasis requiring bronchoscopy: 2, 10%] of which 9 (45%) were reclassified as minor complications (grade II) by the TM&M classification system. According to the TM&M system, 10/34 (29.4%) of all complications were considered minor (grade I or II) while 21/34 (71.4%) as major (IIIa: 8, 23.5%; IIIb: 4, 11.7%; IVa: 8, 23.5%; IVb: 1, 2.9%; V: 3, 8.8%). Other 14 surgical complications occurred and were classified as major complications according to the TM&M system. CONCLUSIONS: The distribution of postoperative complications differs between the two classification systems. The TM&M grading system questions the traditional classification of major complications following VATS lung resection and may be used as an additional endpoint for outcome analyses.
BACKGROUND: The thoracic morbidity and mortality (TM&M) classification system univocally encodes the postoperative adverse events by their management complexity. This study aims to compare the distribution of the severity of complications according to the TM&M system versus the distribution according to the classification proposed by European Society of Thoracic Surgeons (ESTS) Database in a population of patients submitted to video assisted thoracoscopic surgery (VATS) lung resection. METHODS: A total of 227 consecutive patients submitted to VATS lobectomy for lung cancer were analyzed. Any complication developed postoperatively was graded from I to V according to the TM&M system, reflecting the increasing severity of its management. We verified the distribution of the different grades of complications and analyzed their frequency among those defined as "major cardiopulmonary complications" by the ESTS Database. RESULTS: Following the ESTS definitions, 20 were the major cardiopulmonary complications [atrial fibrillation (AF): 10, 50%; adult respiratory distress syndrome (ARDS): 1, 5%; pulmonary embolism: 2, 10%; mechanical ventilation >24 h: 1, 5%; pneumonia: 3, 15%; myocardial infarct: 1, 5%; atelectasis requiring bronchoscopy: 2, 10%] of which 9 (45%) were reclassified as minor complications (grade II) by the TM&M classification system. According to the TM&M system, 10/34 (29.4%) of all complications were considered minor (grade I or II) while 21/34 (71.4%) as major (IIIa: 8, 23.5%; IIIb: 4, 11.7%; IVa: 8, 23.5%; IVb: 1, 2.9%; V: 3, 8.8%). Other 14 surgical complications occurred and were classified as major complications according to the TM&M system. CONCLUSIONS: The distribution of postoperative complications differs between the two classification systems. The TM&M grading system questions the traditional classification of major complications following VATS lung resection and may be used as an additional endpoint for outcome analyses.
Entities:
Keywords:
High-risk patients; complications; lung cancer; video assisted thoracoscopic surgery (VATS) lobectomy
Authors: Subroto Paul; Nasser K Altorki; Shubin Sheng; Paul C Lee; David H Harpole; Mark W Onaitis; Brendon M Stiles; Jeffrey L Port; Thomas A D'Amico Journal: J Thorac Cardiovasc Surg Date: 2010-02 Impact factor: 5.209
Authors: Jelena Ivanovic; Ahmed Al-Hussaini; Derar Al-Shehab; Jennifer Threader; Patrick James Villeneuve; Tim Ramsay; Donna E Maziak; Sebastian Gilbert; Farid M Shamji; R Sudhir Sundaresan; Andrew J E Seely Journal: Ann Thorac Surg Date: 2011-02 Impact factor: 4.330
Authors: Frank C Detterbeck; Sandra Zelman Lewis; Rebecca Diekemper; Doreen Addrizzo-Harris; W Michael Alberts Journal: Chest Date: 2013-05 Impact factor: 9.410
Authors: Bryan M Burt; Andrzej S Kosinski; Joseph B Shrager; Mark W Onaitis; Tracey Weigel Journal: J Thorac Cardiovasc Surg Date: 2014-03-13 Impact factor: 5.209
Authors: Andrew J E Seely; Jelena Ivanovic; Jennifer Threader; Ahmed Al-Hussaini; Derar Al-Shehab; Tim Ramsay; Sebastian Gilbert; Donna E Maziak; Farid M Shamji; R Sudhir Sundaresan Journal: Ann Thorac Surg Date: 2010-09 Impact factor: 4.330