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Survival after resection for primary lung cancer: a population based study of 3211 resected patients. I et al. Pneumonectomy: the burden of death after discharge and predic-tors of surgical mortality. Data from a national lung cancer registry contributes to improve outcome and quality of surgery: Danish results. A case-mix model for monitoring of postoperative mortality after surgery for lung cancer. RJ et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the rando-mized, prospective ACOSOG z0030 trial. Effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.day mortality underestimates the risk of early death after major resections for thoracic malignancies. mortality after resection for lung cancer is nearly double 30-day mortality. after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality. The impact of hospital and surgeon volume on the 30-day mortality of lung cancer surgery: a nation-based reappraisal. To many, the safe conduct of an operation and the successful discharge of a patient is the summation of the surgeon's responsibility. While this is the fundamental responsibility of a surgeon, our role in both the preoperative and postoperative periods has never been more important. One does not have to look too deeply into the literature to see that operative mortality can be defined in many ways, but when we extend the follow-up timeframe, that number becomes frighteningly higher [1, 2]. Operative mortality in most countries has fallen continuously over the last decade. Improved risk stratification, anaesthetic care, pain control and the ability to rescue critically ill patients have all incrementally pushed down our in-hospital mortality. These changes in the perioperative period can set off a cascade of events extending into the postoperative timeframe that can lead to the death of patients after they are discharged. In many cases, we have identified risk factors for those deaths, yet we still struggle A. Green et al. / European Journal of Cardio-Thoracic Surgery 594

When is the burden of responsibility over for the surgeon?