Initial Assessment of the Effect of ProvenCare on Lung Cancer Surgical Quality

Ann Thorac Surg. 2021 Aug 27;S0003-4975(21)01474-0. doi: 10.1016/j.athoracsur.2021.07.080. Online ahead of print.

Abstract

Background: ProvenCare is a joint initiative of the American College of Surgeons Commission on Cancer, Geisinger, and Society of Thoracic Surgeons (STS) to standardize evidence-based practices in the delivery of surgical lung cancer care. We compare outcomes of ProvenCare patients to the STS Database.

Methods: Best practice elements were agreed upon through expert consensus meetings. ProvenCare elements were utilized to direct care. Compliance was monitored while clinical outcomes were collected within the STS General Thoracic Surgery Database (GTSD). ProvenCare patient outcomes were compared to all other STS GTSD patients. Univariable and multivariable logistic regression models compared morbidity and mortality.

Results: A total of 2,026 patients at 23 ProvenCare hospitals were compared to 71,565 controls at 311 hospitals from 2010-2016. ProvenCare patients were more likely to receive guideline recommended staging evaluations and more likely to have mediastinal staging performed during resection (63.4% vs. 49.4%; p<0.001). There was no difference in 30-day mortality (1.4% vs. 1.3% lobectomy, p=0.84; 3.4% vs 2.0% all other resections, p=0.054) or STS indicator complications (10.8% vs. 9.9% lobectomy, p=0.21; 9.2 vs 9.4% all other resections, p=0.92). When controlling for patient-level clinical and demographic risk factors, the likelihood of perioperative morbidity and mortality was not significantly different [OR 1.07 (0.77-1.47) lobectomy; OR 0.97 (0.62-1.50) all other resections].

Conclusions: Variability in pre-operative evaluation of lung cancer patients represents an opportunity to improve quality of care. ProvenCare increased utilization of guideline recommended pre-operative processes, which may improve cancer outcomes and survival, without resulting in differences in short term surgical outcomes.