Meta-analyses of pulmonary morbidity.

<p>Meta-analyses of pulmonary morbidity.</p

Diagram of literature selection.

<p>Diagram of literature selection.</p

Video-Assisted versus Open Lobectomy in Patients with Compromised Lung Function: A Literature Review and Meta-Analysis

<div><p>Background</p><p>It has been suggested that video-assisted (VATS) lobectomy is safer than open lobectomy in patients with compromised lung function, but data regarding this are limited. We assessed acute outcomes of VATS compared to open lobectomy in these high-risk patients using a systematic literature review and meta-analysis of data.</p><p>Methods</p><p>The databases PubMed and Scopus were searched for studies published between 2000 and 2013 that reported mortality and morbidity of VATS in high-risk lung cancer patients defined as having compromised pulmonary or cardiopulmonary function. Study selection, data collection and critical assessment of the included studies were performed according to the recommendations of the Cochrane Collaboration.</p><p>Results</p><p>Three case-control studies and three case series that included 330 VATS and 257 open patients were identified for inclusion. Operative mortality, overall morbidity and pulmonary morbidity were 2.5%, 39.3%, 26.2% in VATS patients and 7.8%, 57.5%, 45.5% in open lobectomy group, respectively. VATS lobectomy patients experienced significantly lower pulmonary morbidity (RR = 0.45; 95% CI, 0.30 to 0.67; <i>p</i> = 0.0001), somewhat reduced operative mortality (RR = 0.51; 95% CI, 0.24 to 1.06; <i>p</i> = 0.07), but no significant difference in overall morbidity (RR = 0.68; 95% CI, 0.41 to 1.14; <i>p</i> = 0.14).</p><p>Conclusion</p><p>The existing data suggest that VATS lobectomy is associated with lower risk for pulmonary morbidity compared with open lobectomy in lung cancer patients with compromised lung function.</p></div

Meta-analyses of operative mortality.

<p>Meta-analyses of operative mortality.</p

Meta-analyses of overall morbidity.

<p>Meta-analyses of overall morbidity.</p

Criteria for considering studies.

<p>VATS = video-assisted thoracic surgery, NSCLC = non-small cell lung cancer, CALGB = Cancer and Leukemia Group B.</p><p>Criteria for considering studies.</p

Search terms.

<p>^aMeSH major topic, only for PubMed.</p><p>Search terms.</p

Characteristics of studies.

<p>CCS = case-control study, CS = case series, FEV₁ = forced expiratory volume in the first second, DLCO = diffusing capacity of the lung for carbon monoxide, FEV1% = FEV₁ as a percent predicted DLCO% = DLCO as a percent predicted, ppoFEV₁% = predicted postoperative FEV₁ expressed as a percent predicted, ppoDLCO% = predicted postoperative DLCO expressed as a percent predicted.</p><p>Characteristics of studies.</p

Risk of bias summary.

<p>Risk of bias summary.</p

Thoracic Surgeons' Perception of Frail Behavior in Videos of Standardized Patients

<div><p>Background</p><p>Frailty is a predictor of poor outcomes following many types of operations. We measured thoracic surgeons' accuracy in assessing patient frailty using videos of standarized patients demonstrating signs of physical frailty. We compared their performance to that of geriatrics specialists.</p><p>Methods</p><p>We developed an anchored scale for rating degree of frailty. Reference categories were assigned to 31 videos of standarized patients trained to exhibit five levels of activity ranging from “vigorous” to “frail.” Following an explanation of frailty, thoracic surgeons and geriatrics specialists rated the videos. We evaluated inter-rater agreement and tested differences between ratings and reference categories. The influences of clinical specialty, clinical experience, and self-rated expertise were examined.</p><p>Results</p><p>Inter-rater rank correlation among all participants was high (Kendall's W 0.85) whereas exact agreement (Fleiss' kappa) was only moderate (0.47). Better inter-rater agreement was demonstrated for videos exhibiting extremes of behavior. Exact agreement was better for thoracic surgeons (n = 32) than geriatrics specialists (n = 9; p = 0.045), whereas rank correlation was similar for both groups. More clinical years of experience and self-reported expertise were not associated with better inter-rater agreement.</p><p>Conclusions</p><p>Videos of standarized patients exhibiting varying degrees of frailty are rated with internal consistency by thoracic surgeons as accurately as geriatrics specialists when referenced to an anchored scale. Ratings were less consistent for moderate degrees of frailty, suggesting that physicians require training to recognize early frailty. Such videos may be useful in assessing and teaching frailty recognition.</p></div