000165705 001__ 165705 000165705 005__ 20260113234335.0 000165705 0247_ $$2doi$$a10.1093/ejcts/ezac122 000165705 0248_ $$2sideral$$a131339 000165705 037__ $$aART-2022-131339 000165705 041__ $$aeng 000165705 100__ $$aRecuero-Díaz, Jose Luis 000165705 245__ $$aTreatment 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 000165705 260__ $$c2022 000165705 5060_ $$aAccess copy available to the general public$$fUnrestricted 000165705 5203_ $$aOBJECTIVES 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 (Γ). 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, Γ = 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. 000165705 540__ $$9info:eu-repo/semantics/openAccess$$aAll rights reserved$$uhttp://www.europeana.eu/rights/rr-f/ 000165705 590__ $$a3.4$$b2022 000165705 591__ $$aSURGERY$$b39 / 213 = 0.183$$c2022$$dQ1$$eT1 000165705 591__ $$aCARDIAC & CARDIOVASCULAR SYSTEMS$$b63 / 143 = 0.441$$c2022$$dQ2$$eT2 000165705 591__ $$aRESPIRATORY SYSTEM$$b33 / 66 = 0.5$$c2022$$dQ2$$eT2 000165705 592__ $$a1.183$$b2022 000165705 593__ $$aCardiology and Cardiovascular Medicine$$c2022$$dQ1 000165705 593__ $$aSurgery$$c2022$$dQ1 000165705 593__ $$aPulmonary and Respiratory Medicine$$c2022$$dQ1 000165705 593__ $$aMedicine (miscellaneous)$$c2022$$dQ1 000165705 594__ $$a5.7$$b2022 000165705 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/acceptedVersion 000165705 700__ $$aRoyo-Crespo, Iñigo 000165705 700__ $$aGómez de-Antonio, David 000165705 700__ $$aCall, Sergi 000165705 700__ $$aAguinagalde, Borja 000165705 700__ $$aGómez-Hernández, María Teresa 000165705 700__ $$aHernández-Ferrández, Jorge 000165705 700__ $$aSánchez-Lorente, David 000165705 700__ $$aSesma-Romero, Julio 000165705 700__ $$aRivo, Eduardo 000165705 700__ $$aMoreno-Mata, Nicolás 000165705 700__ $$0(orcid)0000-0003-0249-3104$$aEmbun, Raul$$uUniversidad de Zaragoza 000165705 7102_ $$11013$$2090$$aUniversidad de Zaragoza$$bDpto. Cirugía$$cÁrea Cirugía 000165705 773__ $$g62, 3 (2022), ezac122 [9 pp.]$$pEur. j. cardio-thorac. surg.$$tEUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY$$x1010-7940 000165705 8564_ $$s510322$$uhttps://zaguan.unizar.es/record/165705/files/texto_completo.pdf$$yPostprint 000165705 8564_ $$s1687204$$uhttps://zaguan.unizar.es/record/165705/files/texto_completo.jpg?subformat=icon$$xicon$$yPostprint 000165705 909CO $$ooai:zaguan.unizar.es:165705$$particulos$$pdriver 000165705 951__ $$a2026-01-13-22:06:25 000165705 980__ $$aARTICLE