Hospital lung surgery volume and patient outcomes

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 129; pp. 22 - 27
• Main Authors: Thai, A.A., Stuart, E., te Marvelde, L., Milne, R.L., Knight, S., Whitfield, K., Mitchell, P.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.03.2019
• Subjects: Aged; Aged, 80 and over; Australia - epidemiology; Carcinoma, Non-Small-Cell Lung - epidemiology; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - surgery; Female; Hospitalization; Hospitals, High-Volume; Humans; Lung Neoplasms - epidemiology; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Male; Middle Aged; Non-small cell lung cancer; Outcomes; Pneumonectomy - statistics & numerical data; Surgery; Surgical volume; Survival; Survival Analysis; Treatment Outcome; Australia; Surgical volume; Survival; Surgery; Outcomes; Non-small cell lung cancer
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2019.01.002

•Historical data suggests an association between survival and the number of surgeries done at a hospital.•In our Australian study, we found no evidence of survival differences in patients between low- and high-volume hospitals for lung cancer surgery.•A higher proportion of patients had an ICU admission ≥24 h in lower volume centres. There has been evidence of an association between patient outcomes and the number of surgeries performed at a hospital. To our knowledge, there are no Australian data on hospital cancer surgery volumes and patient outcomes. We evaluated the relationship between hospital non-small cell lung cancer (NSCLC) surgery volume and patient outcomes in Victoria. Patients with a primary diagnosis of NSCLC between 2008 and 2014 were identified in the Victorian Cancer Registry (n = 15,369), 3,420 (22%) of whom had lung cancer surgery. Primary outcome was death within 90 days of surgery and secondary outcomes included overall survival, use of postoperative ventilation and ≥24hours spent in ICU. Hospital volume was measured as the average number of lung surgeries performed per year, with quartiles Q1: 1–17, Q2: 18–34, Q3: 35–58 and Q4: 59 + . 57% (1,941/3,420) lung cancer patients underwent lobectomy, 38% (1,299/3,420) sub-lobar resection and 5% (180/3,420) pneumonectomy. The overall 90-day mortality after lung surgery was 3.5%, and was 2.6% and 4.5% for patients undergoing lobectomy and sub-lobar resection respectively. There was no difference in 90-day mortality and overall survival between low- and high-volume centres regardless of procedure. Patients operated on in lower volume centres had more admissions to ICU ≥24hours (Q1. 55% vs. Q4. 11%, p-trend <0.001). A higher proportion of patients attending private hospitals (19%) had an ASA score of 4 compared with patients attending a public hospital (9%). We observed no evidence of survival differences between lung cancer patients attending low- and high-volume hospitals for cancer surgery. A higher proportion of patients had an ICU admission ≥24hours in lower volume centres and there are a higher proportion of patients with an ASA score of 4 in private hospitals compared to public hospitals.