• Sarah E Billmeier, John Z Ayanian, Yulei He, Michael T Jaklitsch, and Selwyn O Rogers.
• Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. sbillmeier@partners.org
• Ann. Surg. 2013 Mar 1; 257 (3): 555563555-63.

ObjectiveTo assess factors associated with nursing home admission, severe functional impairment, or death 1 year after surgery for stage I-IIIa non-small cell lung cancer.BackgroundPatients perceive long-term disability to be one of the most undesirable complications of lung cancer treatment.MethodsA multiregional cohort was surveyed 12 months after surgery. Logistic regression was used to determine adjusted predictors of long-term disability. Recursive partitioning was used to create a risk index based on preoperative factors.ResultsOf the 1007 patients, 146 (15%) were admitted to a nursing home or died by 1 year after surgery, with higher risk among patients 80 years or older, those with severe comorbidities, and those with stage II-IIIa disease (all Ps ≤ 0.01). Among 759 survivors who completed the follow-up survey, 51 (7%) were admitted to a nursing home or reported inability to get out of bed, dress or wash themselves, or perform usual activities. Patients with moderate comorbidities (P < 0.001) or lack of high school diploma (P = 0.03) were more likely to experience nursing home admission or severe functional impairment. The risk of nursing home admission, severe functional impairment, or death was low (16%) for patients younger than 75 years and for those 75 years or older with stage I disease, intermediate (33%) for patients 75 years or older with stage II-IIIa disease and no or mild comorbidities, and high (60%) for those 75 years or older with stage II-IIIa disease and moderate or severe comorbidities.ConclusionsPatients' risk of long-term disability should be incorporated in preoperative counseling.

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