Management and outcome of patients undergoing thoracic surgery in a regional chest medical centre

Eur J Anaesthesiol. 2001 Aug;18(8):540-7. doi: 10.1046/j.1365-2346.2001.00890.x.


Background and objective: The main objective of this study was to assess mortality and morbidity after thoracic surgery in a medical centre, without resident chest surgeons and anaesthesiologists, and to determine specific risk factors.

Methods: A prospective cohort study using a local database which includes patients' clinical characteristics, results of preoperative investigations, surgical and anaesthesia data and all postoperative complications was undertaken. Two hundred and seventy-three consecutive patients undergoing thoracic surgery from 1992 to 1999 were studied. The referral chest medical centre was without resident thoracic surgeons or anaesthesiologists; postoperative care was led by local chest physicians according to standardized protocols and in close collaboration with university-based surgeons and anaesthesiologists.

Results: The majority of patients had lung cancer (71%) and underwent resection of at least one lobe (62%). Thirty-day mortality rate was 2.2% and one or more complications occurred in 74 patients (27%). Three patients had to be transferred to a university hospital for further treatment. Univariate predictors of complications included age (> 70 years), history of smoking, body mass index, as well as the extent and duration of surgery. After multiple logistic regression analysis, smoking (current or past), prolonged surgery (>120 min) and major lung resection (pneumonectomy or bilobectomy) remained the only independent risk factors.

Conclusions: Overall perioperative mortality and morbidity rates did not exceed those reported from large teaching hospitals. In selected patients, thoracic surgery can be safely performed in a specialized chest medical centre without on-site surgeons and anaesthesiologists.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anesthesiology
  • Female
  • Hospitals, Teaching
  • Humans
  • Logistic Models
  • Lung Diseases / surgery
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / mortality
  • Prospective Studies
  • Risk Factors
  • Switzerland / epidemiology
  • Thoracic Surgical Procedures / mortality*