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        "titulo" => "Grupo Espa&#241;ol de Cirug&#237;a Tor&#225;cica Videoasistida&#58; M&#233;todo&#44; Auditor&#237;a y Resultados Iniciales de una Cohorte Nacional Prospectiva de Pacientes Tratados con Resecci&#243;n Pulmonar Anat&#243;mica"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Because of improvements in the computerisation&#44; management&#44; and exploitation of clinical data systems&#44; an increasing number of thoracic surgery studies have been derived from population databases or large multicentre registries&#46; In this sense&#44; the classic paradigm of a limited and often insufficient number of patients is being replaced by the greater need to examine the quality and reliability of our data&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> Even within our specialty&#44; the number of studies attempting to analyse and publicise the quality of their recorded data has become exceptional&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Currently&#44; a significant disparity exists regarding the implementation of video-assisted thoracoscopic surgery &#40;VATS&#41; applied to anatomical lung resections at the population level&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;3</span></a> In our country&#44; the most recent reference to the implementation of this surgical technique is included in the survey promoted by the Spanish Society of Thoracic Surgery &#40;SECT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite the extensive literature concluding that VATS is associated with a lower rate of postoperative complications compared with open surgery&#44; the conclusions concerning the effect of the approach on postoperative mortality are uncertain&#44; with major meta-analyses and published population series showing no differences&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> On the other hand&#44; traditional postoperative mortality &#40;in-hospital mortality and&#47;or 30-day mortality&#41; only partially reflect the true surgical risk&#44; which is best represented by the 90-day mortality rate&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The GEVATS project was primarily designed to determine the effect of the eponymous surgery on the 90-day postoperative mortality rate following anatomical lung resection&#46; Its secondary objective was to determine whether VATS influences the long-term oncological prognosis of patients who undergo surgery for lung cancer&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this paper&#44; we present the current practice of VATS in Spain and our initial results regarding the perioperative course after anatomical lung resection&#46; Moreover&#44; we describe the structure&#44; methodology&#44; and quality systems implemented by the GEVATS as well as the possible implications derived from the selection of patients&#44; regardless of intention&#44; of a voluntary multicentre study&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Spanish group of video-assisted thoracic surgery</span><p id="par0030" class="elsevierStylePara elsevierViewall">The GEVATS project of the Spanish Society of Thoracic Surgery &#40;SECT&#41; was founded in May 2015&#44; and all thoracic surgery services of the Spanish National Health System were invited to become members&#46; The research project was approved by the ethics committees of all the participating centres&#44; and informed consent was obtained from the recruited patients to use their clinical data for scientific purposes&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A prospective multicentre cohort study was designed to record all anatomical lung resections performed within each participating department over 15 months &#40;12&#47;20&#47;2016&#8211;03&#47;20&#47;2018&#41;&#46; The oncological monitoring period ends on 03&#47;20&#47;2022&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Bilateral surgical procedures and those performed on patients younger than 18 years old were excluded&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">At the beginning of the study&#44; all the local researchers were informed that every centre would be audited after the recruitment had finished&#46; However&#44; the details of the audit to be undertaken were not intentionally announced&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Database</span><p id="par0050" class="elsevierStylePara elsevierViewall">The programming language used was PHP&#44; under a Symfony development framework&#46; The information was stored in a MySQL database that included 283 variables structured across the following five blocks&#58; baseline characteristics&#44; staging and pathological diagnosis&#44; surgical procedure&#44; postoperative morbimortality and oncological follow-up&#46; Blocks 2 and 5 were relevant only for patients with lung carcinoma&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">All variables were adapted based on the standardisation document of the Society of Thoracic Surgeons &#40;STS&#41; and the ESTS&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> Cases of postoperative morbidity included those occurring during the first 30 days or before discharge&#44; and mortality was recorded at 90 days&#46; Complications were classified based on whether they were respiratory&#44; cardiovascular&#44; or other according to the severity guidelines of the Clavien-Dindo classification&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">VATS was defined by consensus as the absence of rib spreading&#44; regardless of the number of incisions performed&#46; The interested reader can find online more detailed information about the database variables &#40;supplementary material&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sample size</span><p id="par0065" class="elsevierStylePara elsevierViewall">The necessary sample size was calculated based on the primary objective of the study &#40;i&#46;e&#46;&#44; to demonstrate differences in the 90-day mortality rate based on the type of surgical approach&#41;&#46; As such&#44; an independent proportionality analysis was performed using a chi-square test to estimate a mortality of 4&#37; for open surgery &#40;control group&#41; and a mortality of 2&#37; for VATS&#44; with a VATS&#47;open ratio of 1&#58;3&#44; an alpha level of 0&#46;05&#44; a statistical power of 0&#46;8&#44; and a two-tailed hypothesis test&#46; The resulting sample size was 3238 patients &#40;VATS&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>804&#59; open&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2434&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Auditing systems</span><p id="par0070" class="elsevierStylePara elsevierViewall">In addition to the filters in the database itself that served as a quality control during data entry by excluding implausible values and incompatibility between two or more variables&#44; the following monitoring systems were established&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Records with missing values regarding the key variables&#58; &#8220;type of lung resection&#8221;&#44; &#8220;type of surgical approach&#8221;&#44; and &#8220;patient discharge status&#8221; were excluded&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">The recruitment rate of each centre&#44; defined as the percentage of patients registered over all eligible patients &#40;100<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>registered patients&#47;eligible patients&#41;&#44; was validated&#46; To accomplish this goal&#44; the local researcher of each department provided the GEVATS coordinator &#40;RE&#41; with an official document issued by the head of the clinical documentation department of the corresponding hospital indicating the number of lobectomies and pneumonectomies performed during the period of interest &#40;20&#47;12&#47;2016&#8211;20&#47;03&#47;2018&#41; using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems &#40;ICD-10&#41;&#46;</p></li></ul></p><p id="par0085" class="elsevierStylePara elsevierViewall">Because this classification system co-codes atypical resections and anatomical segmentectomies&#44; the latter were not specifically monitored&#46; However&#44; since the ICD-10 codes for lobectomy and pneumonectomy consider whether the surgical approach is endoscopic or open&#44; the recruitment rate validation would allow us to obtain official data on the implementation of VATS&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Centres that recruited fewer than 15 patients or had recruitment rates lower than 10&#37; were excluded&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#41;</span><p id="par0095" class="elsevierStylePara elsevierViewall">For data validation purposes&#44; we considered representative to audit a 20&#37; sample of patients included by each centre &#40;up to a maximum of 20 patients&#41;&#46; This criterion involved the monitoring of 535 patients &#40;i&#46;e&#46;&#44; 15&#46;1&#37; of the entire sample&#41;&#46; The variables audited included the &#8220;date of surgery&#8221;&#44; &#8220;type of lung resection&#8221;&#44; &#8220;type of surgical approach&#8221;&#44; &#8220;length of postoperative stay&#8221;&#44; &#8220;occurrence of postoperative Grade IIIb-V complications&#8221; &#40;respiratory&#44; cardiovascular&#44; or other&#41;&#44; and &#8220;patient discharge status&#8221;&#46;</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">The coordinator and internal scientific committee validated the data&#46; To that end&#44; each local investigator sent their corresponding hospital discharge reports based on a randomised list of recruited patients&#46; Each patient to be audited was identified by the name of the &#46;pdf file of their respective discharge report&#44; which was equivalent to the GEVATS patient code&#46; All other identifying information in the discharge report itself was hidden before being sent to the assigned auditor&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">When necessary&#44; the auditor requested additional and necessary clinical reports to certify the validity of the data &#40;e&#46;g&#46;&#44; surgical protocol&#44; intensive care unit report&#44; and so on&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The similarity between the data recorded in the GEVATS database and those in the official documents was analysed for each department and for each variable audited&#46; Accuracy was expressed as intervals&#44; with an upper accuracy limit &#40;100<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>matching data&#47;verifiable data&#41; and lower accuracy limit &#40;100<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>matching data&#47;all evaluated data&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0115" class="elsevierStylePara elsevierViewall">The descriptive analysis of the data was performed using percentages for the qualitative variables and measures of central tendency &#40;mean or median&#41; and dispersion &#40;standard deviation or 25&#8211;75th percentiles&#41; were used for the quantitative variables depending on data distribution&#46; Data normality was evaluated using the Shapiro&#8211;Wilk test and visual interpretations of the corresponding histograms&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The correlation between the VATS percentages obtained from the administrative reports and the corresponding percentages recorded in the GEVATS database for each hospital were evaluated using Pearson&#39;s correlation coefficient &#40;<span class="elsevierStyleItalic">r</span>&#41; and represented by a scatterplot&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The 33 participating departments were grouped based on their recruitment rate&#58; &#60;80&#37;&#44; 80&#8211;94&#37;&#44; or 95&#8211;100&#37;&#46; The possible effect of low recruitment on the major postoperative variables &#40;i&#46;e&#46;&#44; Grade IIIb-V complications during the first 30 days or before discharge and the 90-day mortality rate&#41; was assessed using unadjusted and adjusted binary logistic regressions for age&#44; sex&#44; type of resection&#44; predictive postoperative forced expiratory volume &#40;FEV1ppo&#41;&#44; and type of surgical approach&#46; The results were expressed as odds ratios &#40;ORs&#41; with their respective 95&#37; confidence intervals &#40;95&#37; CIs&#41; and significance levels &#40;p&#41;&#44; using the group of hospitals with a recruitment rate of 95&#8211;100&#37; as the reference&#46; All data analyses were performed using Stata&#47;MP 14&#46;0&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">The patients recruited and excluded because of the auditing systems are represented in a flowchart &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The number of patients included per hospital ranged from 17 to 264 &#40;mean<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>107&#44; standard deviation<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>57&#46;2&#41;&#44; with a median recruitment rate of 99&#37; &#40;25&#8211;75th percentile interval&#58; 76&#8211;100&#37;&#41; and an overall recruitment rate of 83&#46;3&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Of the 33 departments&#44; 13 reached 100&#37; recruitment &#40;1893 patients&#59; 53&#46;6&#37; of the sample&#41;&#44; six were between 95&#37; and 99&#37; &#40;719 patients&#59; 20&#46;4&#37;&#41;&#44; five were between 80&#37; and 94&#37; &#40;440 patients&#59; 12&#46;4&#37;&#41;&#44; and nine did not reach 80&#37; recruitment &#40;481 patients&#44; 13&#46;6&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">The analysis of the recruitment rate and its association with the presence of severe &#40;Grade IIIb-V&#41; postoperative complications and the 90-day mortality rate&#44; using the group of hospitals with a recruitment rate &#8805;95&#37; as the reference&#44; was not significant&#46; However&#44; the unadjusted regressions revealed that a recruitment rate<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>80&#37; was associated with a tendency to lower postoperative morbidity and 90-day mortality rates &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">The overall percentage of procedures registered as VATS was 54&#46;3&#37; &#40;1917&#47;3533 patients&#41;&#44; with a specific VATS rates for segmentectomy and lobectomy of 65&#46;6&#37; &#40;156&#47;238 pacientes&#41; and 57&#46;4&#37; &#40;1755&#47;3059 patients&#41;&#44; respectively&#46; The percentages of VATS recorded by each hospital in the GEVATS database were highly correlated with the corresponding percentages based on administrative department reports&#44; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;91 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">The overall accuracy percentage regarding the data recorded and the data evaluated based on the clinical reports of hospital discharge was excellent&#44; ranging between 97&#46;7&#37; and 98&#46;5&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">The descriptive analyses of the major baseline&#44; surgical&#44; and postoperative variables&#44; including data quality regarding missing values&#44; are shown in table format &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">The interested reader can find online more detailed information about the database descriptive analysis &#40;supplementary material&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0160" class="elsevierStylePara elsevierViewall">The Spanish VATS Group managed to recruit 3533 anatomical lung resections from 33 thoracic surgery departments in fifteen months &#40;December 2016&#8211;March 2018&#41;&#46; The audit process demonstrated an 83&#37; overall recruitment rate and a 98&#37; data accuracy across all departments&#46; In addition&#44; the data registered showed a 54&#37; VATS rate &#40;65&#46;6&#37; for segmentectomy and 57&#46;4&#37; in case of lobectomy&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Currently&#44; the most commonly accepted quality standards related to the major indicators of the process and outcome of lung resection surgery are derived from the STS and ESTS databases&#46; Recognising the immense potential of these projects to serve as a continuous source of knowledge for our specialty&#44; the representativeness of the US and Europe is challenging&#46; In fact&#44; according to a recent report&#44; the STS database only presented 25&#37; centre and 38&#37; patient penetrance by 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">On the other hand&#44; the representativeness of administrative databases is overshadowed by their deficiencies regarding the analysis of certain indicators&#44; given the lack of specific clinical variables associated with a particular pathology or procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Spain&#44; a country with a predominant National Health System&#44; has 53 public departments of thoracic surgery&#46; Of these departments&#44; 33 &#40;62&#37;&#41; are members of the GEVATS project&#46; Regarding the representation of the Spanish territory&#44; 12 out of 17 Autonomous Communities &#40;71&#37;&#41; and 19 out of 30 &#40;63&#37;&#41; Provinces with at least one thoracic surgery department are represented in our Group&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">According to a report by the Spanish Ministry of Health&#44; 30&#37; of hospital discharges in 2018 derived from the private health system&#46; However&#44; only 9&#8211;10&#37; of major thoracic surgical procedures &#40;code 120 Diagnosis-Related Group&#41; were performed out of a public institution throughout 2016 to 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> Given that the overall recruitment of the GEVATS project was 83&#37;&#44; we could conclude that our sample included&#44; approximately&#44; 50&#37;of the anatomical lung resections performed in our country during the study period&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Since the Spanish multicentre cooperative group dealing with videothoracoscopy for minor procedures &#40;1573 patients&#44; registered from 1996 to 1998&#41;&#44; different nationwide surgical cohort studies and benchmarking projects have been developed in our country&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12&#8211;16</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Recently&#44; the results of the Spanish multicentre prospective cohort study of the Group of Postoperative Complications of the Spanish Society of Thoracic Surgeons &#40;GPC-SECT&#41;&#44; has published the first known results about VATS implementation in Spain for lung cancer&#46; This study registered 3307 patients operated on for lung cancer in 24 national thoracic surgery departments between June 2012 and November 2014&#46; The percentages of VATS were 30&#46;4&#37; in men and 34&#46;3&#37; in women &#40;9&#46;3&#37; of patients in that study underwent wedge resection&#41;&#44; which means that the VATS implantation in our country&#44; has nearly doubled after 5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">One of the major handicaps of any voluntary database is the potential bias related to selection of patients to be included&#46; In this sense&#44; few studies have attempted to analyse and demonstrate this selection using administrative data or other mandatory population registers as a reference&#46; In addition&#44; studies that have attempted to demonstrate how this selection might influence the results and conclusions of a multicentric&#44; national&#44; and&#47;or continental registry or database are rare&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> In our study&#44; although we did not find a significant association between a lower recruitment rate and a lower complication rate&#44; a trend was clearly present in the unadjusted analysis&#46; The reasons for participating centres to optimise recruitment were not required but both&#44; the loss of interest in the study and the necessary effort for data entry&#44; could play definitive roles&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The estimates for sample size were only partially successful&#44; since the percentage of VATS registered &#40;54&#37;&#41; was notably higher than the expected value &#40;25&#37;&#41;&#46; However&#44; the estimated and registered values of 90-day mortality rates for VATS &#40;registered vs estimated 2&#37;&#41; and open surgery &#40;registered 4&#46;9&#37; vs estimated 4&#37;&#41; were somehow similar&#46; This way&#44; the recalculated sample size&#44; based on the registered data&#44; would have result in a sample of 718 patients &#40;VATS 389 and Open 329 patients&#41;&#46; Therefore&#44; we can conclude that the GEVATS cohort will even allow stratified and propensity score analyses with enough statistical power as to obtain robust conclusions&#46; The opportunity of clinical analyses based only on those centres with a 100&#37; recruitment rate &#40;1893 patients&#59; 53&#46;6&#37; of the sample&#41;&#44; could be another interesting chance for future projects related to the GEVATS cohort&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Although the validation of recorded data in multicentre registries is gaining popularity over the last years&#44; the proportion of centres and patients audited is consistently low&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">19&#8211;21</span></a> In this regard&#44; the recruitment rate of all the GEVATS departments and a stratified random sample of our cohort &#40;15&#37; of patients&#41; were audited&#44; including the most clinically significant variables or those considered as potential sources of conflict of interest&#46; Agreement rate between our registered and official data were consistently high throughout the six key variables audited&#44; in consonance with the results obtain by the STS database audits&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">The proportion of missing values is another known quality parameter of a database&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> Regarding the 242 variables comprising the four blocks analysed &#40;baseline characteristics&#44; diagnosis and staging&#44; surgery&#44; and postoperative period&#41;&#44; the percentage of missing values was 0&#46;95&#37;&#46; This value is excellent in terms of completion and perhaps the result of the design and filters implemented in the database&#44; both of which were key during data entry&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Regarding our clinical results&#44; the VATS lobectomy rate of 57&#46;4&#37; is worth mentioning because it is more consistent with the data published by the major North American databases than with the results derived from the European registry&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;3&#44;24</span></a> Rates in excess of 50&#37; in Europe have been published by the Dutch National Registry of Lung Surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> Our in-hospital mortality rate &#40;1&#46;6&#37;&#41; and 90-day mortality rate &#40;2&#46;9&#37;&#41; are in line with or even lower than those published in other national studies&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limitations</span><p id="par0220" class="elsevierStylePara elsevierViewall">Given the voluntary nature of GEVATS and its manifest interest in minimally invasive surgery&#44; one of our major limitations is related to the representativeness of the practice of VATS in Spain&#46; Although 90&#37; of the thoracic surgery departments in Spain have some degree of experience in performing anatomical lung resections via VATS &#40;national survey&#44; 2015&#41;&#44; the actual figures might differ from those reported in this study&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">On the other hand&#44; the auditing systems&#44; excluding the reports issued by the departments of clinical documentation&#44; were implemented by some of the member thoracic surgeons of GEVATS &#40;the coordinator and the internal scientific committee&#41; and not by a professional external auditing service&#44; which might have influenced the reliability of our results&#46; However&#44; because one of the criteria to be audited was the degree of severity of postoperative complications&#44; we emphasise the importance of the experience of the clinical professional in this regard&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">The GEVATS cohort represents&#44; to date&#44; the most ambitious prospective study of the Spanish thoracic surgery&#44; regarding the number of centres involved&#44; the total sample size&#44; and the auditing systems implemented&#46; Our results suggest that VATS is widely implemented in Spain&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Although our series did not demonstrate a significant association &#40;only a trend between lower postoperative complications and lower recruitment rates&#41;&#44; we believe that this parameter and its possible implications should deserve further attention by the main ongoing and future voluntary registries and multicentre studies of surgical series&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Last&#44; the significant representativeness and excellent quality of our data will allow us to obtain highly reliable results in future projects&#44; in which the effect of the surgical technique will be one of our primary foci&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding statement</span><p id="par0245" class="elsevierStylePara elsevierViewall">All costs related to the start-up and maintenance of the GEVATS database were covered by Ethicon&#44; Johnson &#38; Johnson&#46; The authors had freedom of investigation and full control of the design of the study&#44; methods used&#44; outcome parameters and results&#44; data analysis&#44; and production of the written report&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The GEVATS was awarded a grant from the Spanish Society of Thoracic Surgery as the best national research project of 2015&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of interest</span><p id="par0255" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Our study sought to know the current implementation of video-assisted thoracoscopic surgery &#40;VATS&#41; for anatomical lung resections in Spain&#46; We present our initial results and describe the auditing systems developed by the Spanish VATS Group &#40;GEVATS&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12&#47;20&#47;2016 and 03&#47;20&#47;2018&#46; The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables&#46; The implications of a low recruitment rate were analysed for &#8220;90-day mortality&#8221; and &#8220;Grade IIIb-V complications&#8221;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The series was composed of 3533 cases &#40;1917 VATS&#59; 54&#46;3&#37;&#41; across 33 departments&#46; The centres&#8217; median recruitment rate was 99&#37; &#40;25&#8211;75th&#58;76&#8211;100&#37;&#41;&#44; with an overall recruitment rate of 83&#37; and a data accuracy of 98&#37;&#46; We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity&#47;mortality&#44; but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80&#37; &#40;centres with 95&#8211;100&#37; rates as reference&#41;&#58; grade IIIb-V OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;61 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;081&#41;&#44; 90-day mortality OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;46 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;051&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">More than half of the anatomical lung resections in Spain are performed via VATS&#46; According to our results&#44; the centre&#39;s recruitment rate and its potential implications due to selection bias&#44; should deserve further attention by the main voluntary multicentre studies of our speciality&#46; The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio busc&#243; conocer el grado de implementaci&#243;n actual de la cirug&#237;a toracosc&#243;pica asistida por video &#40;VATS&#44; por sus siglas en ingl&#233;s&#41; para las resecciones pulmonares anat&#243;micas en Espa&#241;a&#46; Presentamos nuestros resultados iniciales y describimos los sistemas de auditor&#237;a desarrollados por el grupo espa&#241;ol de VATS &#40;GEVATS&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio de cohortes prospectivo multic&#233;ntrico que incluy&#243; pacientes que fueron tratados con resecciones pulmonares anat&#243;micas entre el 20&#47;12&#47;2016 y el 20&#47;03&#47;2018&#46; Los controles de calidad principales consistieron en determinar la tasa de reclutamiento de cada centro y la precisi&#243;n de los datos perioperatorios recolectados en base a seis variables clave&#46; Se analizaron las implicaciones de una baja tasa de reclutamiento para &#8220;mortalidad a los 90 d&#237;as&#8221; y &#8220;complicaciones de grado IIIb-V&#8221;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La serie estaba compuesta por 3533 casos &#40;1917 VATS&#59; 54&#44;3&#37;&#41; en 33 servicios&#46; La mediana de la tasa de reclutamiento de los centros fue del 99&#37; &#40;p25-p75&#58; 76-100&#37;&#41;&#44; con una tasa de reclutamiento global del 83&#37; y una precisi&#243;n de los datos del 98&#37;&#46; No pudimos demostrar una asociaci&#243;n significativa entre la tasa de reclutamiento y el riesgo de morbi-mortalidad&#44; pero se encontr&#243; una tendencia en el an&#225;lisis no ajustado para aquellos centros con tasas de reclutamiento inferiores al 80&#37; &#40;usando los centros con tasas de 95-100&#37; como referencia&#41;&#58; <span class="elsevierStyleItalic">OR</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;61 para el grado IIIb-V &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;081&#41;&#44; <span class="elsevierStyleItalic">OR</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;46 para la mortalidad a los 90 d&#237;as &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;051&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">M&#225;s de la mitad de las resecciones pulmonares anat&#243;micas en Espa&#241;a se realizan a trav&#233;s de VATS&#46; Seg&#250;n nuestros resultados&#44; la tasa de reclutamiento del centro y sus posibles implicaciones debido al sesgo de selecci&#243;n&#44; deber&#237;an recibir m&#225;s atenci&#243;n por parte de los principales estudios multic&#233;ntricos voluntarios de nuestra especialidad&#46; La alta representatividad y la confiabilidad de los datos de GEVATS constituyen un punto de partida fundamental para esta cohorte nacional&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
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            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0270" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0075"
          ]
        ]
      ]
    ]
    "multimedia" => array:9 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Audit process&#46; Flow chart representing the number of GEVATS patients and departments regarding the different auditing stages&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1172
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Recruitment by centre&#46; Number of patients registered per centre and their respective recruitment rates based on the reports of the clinical documentation departments of each hospital&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1530
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            "Tamanyo" => 95150
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Surgical approach audit&#46; Relationship between the percentage of VATS procedures based on the data recorded in the GEVATS database and the reports of the respective clinical documentation departments&#59; each rhombus corresponds to a GEVATS centre&#59; Pearson&#39;s correlation coefficient &#40;<span class="elsevierStyleItalic">r</span>&#41;&#46;</p>"
        ]
      ]
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          "notaPie" => array:4 [
            0 => array:3 [
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            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Adjusted the following variables&#58; age &#40;quantitative&#41;&#44; sex&#44; type of lung resection &#40;segmentectomy&#44; lobectomy-bilobectomy&#44; or pneumonectomy&#41;&#44; type of surgical approach &#40;VATS or open surgery&#41;&#44; and FEV1ppo &#40;quantitative&#41;&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Group of five departments &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>440 patients&#41; with a recruitment rate between 80&#37; and 94&#37;&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Group of nine departments &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>481 patients&#41; with a &#60;80&#37; recruitment rate&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Risks of major postoperative complications and mortality &#40;30 days or before discharge&#41; and the 90-day mortality based on the recruitment rate &#40;19 departments with a 95&#8211;100&#37; recruitment rate were used as the reference group&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2612 patients&#41;&#46;</p>"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Accurate data&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No verifiable data&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No accurate data&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valuable data&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">All data&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Upper accuracy rate<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower accuracy rate<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery date<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">531&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">531&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">535&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Type of surgical approach<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">517&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">524&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">535&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Type of lung resection<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">525&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">534&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">535&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade IIIb-IV complications<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">527&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">535&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postoperative stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">505&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">529&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">535&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Discharge status<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">532&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">535&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3137&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2423028.png"
              ]
            ]
          ]
          "notaPie" => array:6 [
            0 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Inclusion criteria for GEVATS&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">VATS vs open surgery&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Based on the assessment of three complication groups &#40;12 respiratory&#44; seven cardiovascular&#44; and seven other&#41; and severity according to the Clavien-Dindo classification&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Living vs dead&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0045"
              "etiqueta" => "e"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0045">&#40;Matching data&#47;verifiable data&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tblfn0050"
              "etiqueta" => "f"
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                  \t\t\t\t">238&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumonectomy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">236&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">VATS approach</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Biportal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Three or more ports&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">520&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Uniportal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">165&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Conversion from VATS to Open</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">361&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Postoperative stay &#40;median&#59; 25&#8211;75th&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 days &#40;4&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In-hospital mortality</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VATS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Open&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">90-Day mortality</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VATS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Open&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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