Hospital lung surgery volume and patient outcomes

A A Thai; E Stuart; L Te Marvelde; R L Milne; S Knight; K Whitfield; P Mitchell

doi:10.1016/j.lungcan.2019.01.002

Hospital lung surgery volume and patient outcomes

Lung Cancer. 2019 Mar:129:22-27. doi: 10.1016/j.lungcan.2019.01.002. Epub 2019 Jan 10.

Authors

A A Thai¹, E Stuart², L Te Marvelde², R L Milne³, S Knight⁴, K Whitfield⁵, P Mitchell⁶

Affiliations

¹ Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
² Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia; Cancer Strategy & Development, Department of Health and Human Services, 50 Lonsdale St, Melbourne, Victoria, 3000, Australia.
³ Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia.
⁴ Department of Surgery, Austin Health, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
⁵ Cancer Strategy & Development, Department of Health and Human Services, 50 Lonsdale St, Melbourne, Victoria, 3000, Australia.
⁶ Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. Electronic address: paul.mitchell@austin.org.au.

PMID: 30797487
DOI: 10.1016/j.lungcan.2019.01.002

Abstract

Objectives: 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.

Materials and methods: 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 + .

Results: 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%).

Conclusion: 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.

Keywords: Non-small cell lung cancer; Outcomes; Surgery; Surgical volume; Survival.

Publication types

Comparative Study

MeSH terms

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
Pneumonectomy / statistics & numerical data*
Survival Analysis
Treatment Outcome