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GEVATS is supported by Ethicon and Spanish Society of Thoracic Surgery.

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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

Publicated to:EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. 62 (3): NULL- - 2022-02-25 62(3), DOI: 10.1093/ejcts/ezac122

Authors: Luis Recuero-Diaz, Jose; Royo-Crespo, Inigo; Gomez de-Antonio, David; Call, Sergi; Aguinagalde, Borja; Teresa Gomez-Hernandez, Maria; Hernandez-Ferrandez, Jorge; Sanchez-Lorente, David; Sesma-Romero, Julio; Rivo, Eduardo; Moreno-Mata, Nicolas; Embun, Raul;Spanish Grp Video-assisted Thoraci

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Abstract

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.

Keywords

90-day mortalityanatomical lung resectionintention-to-treat analysislung cancerthoracic surgery90-day mortalityAnatomical lung resectionIntention-to-treat analysisLung cancerMatched analysisMorbidityOpen lobectomyOutcomesRiskSocietyThoracic surgeryThoracoscopic surgeryThoracotomyVideo-assisted thoracic surgery

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 39/213, thus managing to position itself as a Q1 (Primer Cuartil), in the category Surgery.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 2.23, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-27, the following number of citations:

  • WoS: 2
  • Scopus: 4
  • OpenCitations: 3

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-27:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 5.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 5 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 8.5.
  • The number of mentions on the social network X (formerly Twitter): 11 (Altmetric).