Context: Lung resection can lead to significant
postoperative complications: Although many reports describe the
likelihood of postoperative problems, such as atelectasis, pneumonia,
and prolonged ventilator dependence, it is unclear whether patients
perceive these outcomes as sufficiently severe to influence their
decisions about surgery.
Objective: To assess
patients’ preferences regarding possible outcomes of lung resection,
including traditional complications reported in the lung surgery
literature and outcomes that describe functional limitation.
Design: Utility analysis.
community hospital internal medicine clinic, a private internal
medicine practice, and a private pulmonary practice.
Participants: Sixty-four patients, aged 50 to 75 years, who
were awaiting appointments at the designated clinic sites.
Main outcome measure: Patients’ strength of preference
regarding potential outcomes of lung resection as derived from health
Results: Common postoperative
complications were assigned high utility scores by patients. On a scale
for which 1.0 represents perfect health and 0 represents death,
postoperative atelectasis, pneumonia, and 3 days of mechanical
ventilation were all rated >0.75. Scores describing limited physical
function were strikingly low. Specifically, activity limited to bed to
chair movement and the need for complete assistance with activities of
daily living were all assigned utility scores <0.2. Twenty-four-hour
oxygen dependence was scored at 0.33. Presence or absence of pulmonary
illness did not predict scores for any outcome.
Conclusions: Whether patients suffer from chronic lung
disease or not, they do not regard the postoperative outcomes reported
in the lung surgery literature as sufficiently morbid to forego
important surgery. However, physical debility is perceived as extremely
undesirable, and anticipation of its occurrence could deter surgery.
Therefore, identification of preoperative predictors of postoperative
physical debility would be invaluable for counseling patients who face
difficult decisions about lung resection.