The Clinical Impact of Heart Failure on the Postoperative Outcomes for Lung Cancer Patients Undergoing Lobectomy and Sublobar Resection by Video-Assisted Thoracic Surgery: A Propensity Score-Matched Analysis of 2016-2020 HCUP-NIS Data

Background: The clinical impact of heart failure (HF) on postoperative outcomes following video-assisted thoracic surgery (VATS) for lung cancer resection remains controversial. This study aimed to assess patient and hospital characteristics related to the type of surgery, as well as the independent impact of HF on surgical outcomes. Methods: We conducted a retrospective analysis using data from the National Inpatient Sample database. A total of 20 693 patients aged 18 years or older, diagnosed with lung cancer, and undergoing lobectomy or sublobar resection via VATS between 2016 and 2020 were included. Patients were stratified based on the presence of HF. The HF-present cohorts were matched to HF-absent controls using a 1:2 nearest-neighbor propensity score-matching (PSM) analysis. The matched cohorts were then compared across several endpoints, including mortality, length of stay (LOS), hospitalization costs, and postoperative complications. Results: After PSM, the study included 1781 patients who underwent lobectomy and 1157 who underwent sublobar resection, with 594 and 386 patients, respectively, having concurrent HF. In both the lobectomy and sublobar resection groups, patients with HF demonstrated significantly higher in-hospital mortality rates ( P < .001), longer LOS ( P < .001), increased total hospital charges ( P < .001), and a greater risk for overall postoperative complications ( P < .001). Conclusions: Among patients with lung cancer undergoing VATS, the presence of HF is associated with an increased risk of postoperative complications. This finding underscores the necessity for enhanced monitoring and care for patients with HF should be treated during the postoperative recovery phase.