Hospital lung surgery volume and patient outcomes
•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 admis...
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Published in | Lung cancer (Amsterdam, Netherlands) Vol. 129; pp. 22 - 27 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
Ireland
Elsevier B.V
01.03.2019
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Subjects | |
Online Access | Get full text |
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Summary: | •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. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0169-5002 1872-8332 |
DOI: | 10.1016/j.lungcan.2019.01.002 |