Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit

Introduction For appropriately staged non-small cell lung cancer (NSCLC) surgical resection can dramatically improve survival, but some may not be offered this treatment because of concerns about perioperative mortality. Methods We used data from the National Lung Cancer Audit (NLCA) to determine the proportions of English patients who died within 30 and 90days after surgery for NSCLC. We quantified the predictors of early postoperative death and using these results devised a score to predict risk of death within 90days of surgery. Results We analysed data on 10991 patients operated on between 2004 and 2010. Three per cent (334) of patients died within 30days of their procedure and 5.9% (647) within 90days. Age was strongly associated with early postoperative death (adjusted OR within 90days for 80-84years vs 70-74years: 1.46, 95% CI 1.07 to 1.98); significant associations were also observed with performance status (PS) (adjusted OR within 90days for PS 2 vs PS 0: 2.40, 95% CI 1.68 to 3.41), as well as lung function, stage and procedure type. Conclusions Our results show that age is the most important predictor of death within both of these early postoperative periods. We used the data in the NLCA to develop a predictive score, based on an English population and specific to lung cancer surgery, which estimates risk of death within 90days; this score should be tested in future cohorts.