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Volume 11
Issue 19
10.3390/jcm11195774
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Article
Peer-Review Record

Risk Factors for Postoperative Pulmonary Complications Leading to Increased In-Hospital Mortality in Patients Undergoing Thoracotomy for Primary Lung Cancer Resection: A Multicentre Retrospective Cohort Study of the German Thorax Registry

J. Clin. Med. 2022, 11(19), 5774; https://doi.org/10.3390/jcm11195774
by Wolfgang Baar 1,*, Axel Semmelmann 1, Julian Knoerlein 1, Frederike Weber 1, Sebastian Heinrich 1,† and Torsten Loop 1,2,† on behalf of Working Group of the German Thorax Registry
Reviewer 1: Anonymous
Reviewer 2: Anonymous
J. Clin. Med. 2022, 11(19), 5774; https://doi.org/10.3390/jcm11195774
Submission received: 5 August 2022 / Revised: 24 September 2022 / Accepted: 26 September 2022 / Published: 29 September 2022
(This article belongs to the Special Issue Anesthesia and Analgesia for High-Risk Pulmonary Patients)

Round 1

Reviewer 1 Report

This paper has a good scientific level and it is of interest for anesthesiologist, intensive care physicians or pneumologists. It includes a lot of patients and results, although predictable, have a good statistic significance.

I have one concern regarding the homogeneity among the anesthetic techniques and postoperative control of analgesia between hospitals/centers. The different approaches could have an important impact on postoperative pulmonary complication.

This should be discuss and add at the limitations of this study.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Dear authors,

You present a retrospective analysis of patients undergoing OTLR for lung cancer. I believe your study is interesting and well-written. Subsequently, I have but a few comments:

- Why did you choose 195 minutes as a cutoff for length of surgery? This seems like a rather random cutoff time. In your previous study, you used 120 minutes as a cutoff, and for reasons of consistency I would stay with that.

- You note that the „amount of intraoperative blood loss (OR 1.6, 95% CI 1.2-2.1, P=0.001)“ is a significant factor for PPC. What was the cutoff you defined (you must have had a cutoff or a step-wise approach if you present an OR)?

- I would suggest naming the four contributing centers.

- I would suggest to present the p values as „<0.001“ instead of „0.000“ in Figure 1 and the tables. You may also want to consider switching from „1.368“ to „1,368“ etc. in Figure 1.

- You discuss the intriguing pneumonectomy findings. Is it possible that patient selection also plays a role? For pneumonectomy patients, surgeons may apply stricter criteria regarding operability. Patients too unfit for surgery may be offered radio(chemo)therapy instead. Similarly, patients with a high ASA may also be well-selected for surgery.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

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