Treatment and intention-to-treat propensity score analysis to evaluate the impact of video-assisted thoracic surgery on 90-day mortality after anatomical resection for lung cancer
Por:
Recuero-Diaz, J, Royo-Crespo, I, de-Antonio, D, Call, S, Aguinagalde, B, Gomez-Hernandez, M, Hernandez-Ferrandez, J, Sanchez-Lorente, D, Sesma-Romero, J, Rivo, E, Moreno-Mata, N and Embun, R
Publicada:
3 ago 2022
Ahead of Print:
1 feb 2022
Resumen:
OBJECTIVES: The aim of this study was to know the treatment effect of video-assisted thoracic surgery (VATS) on 90-day mortality after anatomical lung resection based on a nationwide cohort.
METHODS: This is a multicentre prospective cohort of 2721 anatomical resections for lung cancer from December 2016 to March 2018. Treatment and intention-to-treat (ITT) analyses were performed after inverse probability score weighting and different propensity score matching algorithms. Covariate balance was assessed by standardized mean differences. The estimators reported were the average treatment effect, the average treatment effect on the treated and odds ratios after conditional logistic models with 95% confidence intervals. The unconfoundedness assumption was evaluated by sensitivity analysis for average treatment effect (c-dependence) and average treatment effect on the treated (Gamma).
RESULTS: VATS was the initial approach in 1911 patients (70.2%), though 273 cases (14.3%) had to be converted to thoracotomy. Ninety-day mortality rates were: treatment analysis (VATS 1.16% vs open 3.9%, P < 0.001), ITT analysis (VATS 1.78% vs open 3.36%, P = 0.012). After inverse probability score weighting and propensity score matching, in the treatment analysis, VATS meant absolute risk reductions between 2.25% and 2.96% and relative risk reductions between 65% and 70% [OR= 0.34 (95% confidence interval 0.15-0.79), all P-values <0.004). However, all the estimators turned out to be non-significant in the ITT analyses. A high sensitivity to unobservable confounders was proved (c-dependence 0.135, Gamma = 1.5).
CONCLUSIONS: VATS can reduce the risk of 90-day mortality after anatomical lung resection. However, the implications of conversion to thoracotomy, comparing ITT versus treatment analysis, and the potential impact of hidden bias should deserve further attention in the future.
Filiaciones:
Recuero-Diaz, J:
Hosp Clin Univ Lozano Blesa, Hosp Univ Miguel Servet, Dept Thorac Surg, IIS Aragon, Zaragoza, Spain
Royo-Crespo, I:
Hosp Clin Univ Lozano Blesa, Hosp Univ Miguel Servet, Dept Thorac Surg, IIS Aragon, Zaragoza, Spain
de-Antonio, D:
Hosp Univ Puerta Hierro Majadahonda, Dept Thorac Surg, Madrid, Spain
Call, S:
Univ Barcelona, Hosp Univ Mutua Terrasa, Dept Thorac Surg, Barcelona, Spain
Aguinagalde, B:
Hosp Univ Donostia, Dept Thorac Surg, Donostia San Sebastian, Spain
Gomez-Hernandez, M:
Univ Salamanca, Hosp Univ Salamanca, Dept Thorac Surg, IBSAL, Salamanca, Spain
Hernandez-Ferrandez, J:
Hosp Univ Sagrat Cor, Dept Thorac Surg, Barcelona, Spain
Sanchez-Lorente, D:
Univ Barcelona, Hosp Clin Barcelona, Inst Respiratorio, Dept Thorac Surg, Barcelona, Spain
:
Hosp Gen Univ Alicante, Dept Thorac Surg, Alicante, Spain
Rivo, E:
Hosp Univ Santiago Compostela, Dept Thorac Surg, Santiago De Compostela, Spain
Moreno-Mata, N:
Hosp Ramon & Cajal, Dept Thorac Surg, Madrid, Spain
Embun, R:
Hosp Clin Univ Lozano Blesa, Hosp Univ Miguel Servet, Dept Thorac Surg, IIS Aragon, Zaragoza, Spain
Univ Zaragoza, Fac Med, Dept Surg, Zaragoza, Spain
Open Access
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