Clinical and financial outcomes of pulmonary resection for lung cancer in safety-net hospitals

Sara Sakowitz; Arjun Verma; Russyan Mark Mabeza; Nam Yong Cho; Joseph Hadaya; Paul Toste; Peyman Benharash

doi:10.1016/j.jtcvs.2022.09.036

Clinical and financial outcomes of pulmonary resection for lung cancer in safety-net hospitals

J Thorac Cardiovasc Surg. 2023 Apr;165(4):1577-1584.e1. doi: 10.1016/j.jtcvs.2022.09.036. Epub 2022 Sep 27.

Authors

Sara Sakowitz¹, Arjun Verma¹, Russyan Mark Mabeza¹, Nam Yong Cho¹, Joseph Hadaya¹, Paul Toste², Peyman Benharash³

Affiliations

¹ Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
² Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
³ Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, Calif; Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif. Electronic address: PBenharash@mednet.ucla.edu.

PMID: 36328819
DOI: 10.1016/j.jtcvs.2022.09.036

Abstract

Objective: Safety-net hospitals (SNHs) have previously been associated with inferior outcomes and greater resource use. However, this relationship has not been explored in the contemporary setting of pulmonary lobectomy. In the present national study we characterized the association between SNHs and mortality, complications, and resource use.

Methods: All adults (18 years of age or older) who underwent elective lobectomy for lung cancer were identified within the 2010 to 2019 Nationwide Readmissions Database. Hospitals in the highest quartile of safety-net burden were categorized as SNHs, and others non-SNHs. Multivariable regressions were developed to assess the independent association between safety-net status and outcomes of interest.

Results: Of an estimated 282,011 patients who met inclusion criteria, 41,015 (14.5%) were treated at SNHs. Patients at SNHs were younger but as commonly female, compared with non-SNHs. After multivariable adjustment, there was no association between SNHs and mortality. However, treatment at SNHs was linked to higher odds of pneumonia (adjusted odds ratio [AOR], 1.11; 95% CI, 1.02-1.21) and prolonged ventilation (AOR, 1.36; 95% CI, 1.11-1.66), as well as infectious (AOR, 1.24; 95% CI, 1.08-1.43), intraoperative (AOR, 1.22; 95% CI, 1.07-1.39), and overall complications (AOR, 1.07; 95% CI, 1.01-1.14). Patients at SNHs also showed a greater need for a blood transfusion (AOR, 1.37; 95% CI, 1.23-1.53). In addition, SNHs were associated with increased length of stay (+0.33 days; 95% CI, 0.17-0.48) and greater costs (+$4130; 95% CI, 3.34-4.92), relative to non-SNHs.

Conclusions: Hospital safety-net status was associated with greater odds of perioperative complications and greater health care expenditure. Further investigation is necessary uncover the mechanisms contributing to these complications and eradicate persistent disparities in lobectomy.

Keywords: clinical outcomes; disparities; lobectomy; lung cancer; safety-net hospitals.

MeSH terms

Adolescent
Adult
Female
Hospitals
Humans
Lung Neoplasms*
Safety-net Providers*
United States