• Annals of surgery · Jun 2023

    Long-Term Functional Outcomes Among Older Adults Undergoing Video-Assisted Versus Open Surgery for Lung Cancer: A Population-Based Cohort Study.

    • Julie Hallet, Mathieu Rousseau, Vaibhav Gupta, Dhruvin Hirpara, Haoyu Zhao, Natalie Coburn, Gail Darling, Biniam Kidane, and Members of the REcovery After Surgical Therapy for Older Adults Research – Cancer (RESTORE-Cancer) Group.
    • Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
    • Ann. Surg. 2023 Jun 1; 277 (6): e1348e1354e1348-e1354.

    ObjectiveTo examine the long-term healthcare dependency outcomes of older adults undergoing VATS compared to open lung cancer resection.Summary Of Background DataAlthough the benefits of VATS for lung cancer resection have been reported, there is a knowledge gap related to long-term functional outcomes central to decision-making for older adults.MethodsWe conducted a population-based retrospective comparative cohort study of patients ≥70 years old undergoing lung cancer resection between 2010 and 2017 using linked administrative health databases. VATS was compared to open surgery for lung cancer resection. Outcomes were receipt of homecare and high time-at-home, defined as <14 institution-days within 1 year, in 5 years after surgery. We used time-to-event analyses. Homecare was analyzed as recurrent dichotomous outcome with Andersen-Gill multivariable models, and high time-at-home with Cox multivariable models.ResultsOf 4974 patients, 2951 had VATS (59.3%). In the first three months postoperatively, homecare use ranged from 17.5% to 34.4% for VATS and 23.0% to 36.6% for open surgery. VATS was independently associated with lower need for postoperative homecare over 5 years (hazard ratio 0.82, 95% confidence interval 0.74-0.92). 1- and 5-year probability of high "time-at-home" were superior for VATS (74.4% vs 66.7% and 55.6% vs 45.4%, p < 0.001). VATS was independently associated with higher probability of high "time-at-home" (hazard ratio 0.81, 95% confidence interval 0.74-0.89) compared to open surgery.ConclusionsCompared to open surgery, VATS was associated with lower homecare needs and higher probability of high "time-at-home," indicating reduced long-term functional dependence. Those important patient-centered endpoints reflect the overall long-term treatment burden on mortality and morbidity that can inform surgical decision-making.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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