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Impact of hospital volume of thoracoscopic lobectomy on primary lung cancer outcomes.
Ann Thorac Surg. 2012 Feb; 93(2):372-9.AT

Abstract

BACKGROUND

This study evaluated hospital operative volume of video-assisted thoracoscopic surgery (VATS) lobectomy in primary lung cancer as a predictor of short-term outcomes after pulmonary lobectomy on a national scale. Some previous analyses comparing VATS vs open lobectomy outcomes have been limited by inaccuracies in patient cohort identification.

METHODS

The 2008 Healthcare Utilization Project-Nationwide Inpatient Sample database was culled using the International Classification of Diseases (9th Clinical Modification) procedure codes specifically distinguishing VATS vs open lobectomies (32.41 and 32.49, respectively) available only after October 2007. High hospital VATS volume was defined as 95th percentile or higher (>20 VATS/year). Univariable and multivariable analyses were used to identify independent predictors of the following outcome measures: 30-day in-hospital morbidity and mortality, hospital length of stay (LOS), and hospital costs.

RESULTS

We identified 6,292 primary lung cancer patients undergoing pulmonary lobectomy, including 1,523 undergoing VATS (24%). Compared with open, VATS patients had fewer complications (38% vs 44%, p<0.001) and median LOS (5 vs 7 days; p<0.001). In multivariable analysis, VATS was an independent predictor of fewer total complications (odds ratio, 0.83; p=0.004) and shorter LOS (2.3±0.3-day difference, p<0.001). Patients undergoing VATS at high-volume VATS hospitals had shorter median LOS (4 vs 6 days, p=0.001) compared with low-volume VATS hospitals. Multivariable analysis showed high hospital VATS volume independently predicted shorter LOS (0.9±0.4-day difference, p=0.001).

CONCLUSIONS

In a national database, VATS lobectomy was associated with fewer complications and shorter LOS than open lobectomy in primary lung cancer patients. Among patients undergoing VATS, high hospital volume was also associated with shorter LOS.

Authors+Show Affiliations

Section of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21945225

Citation

Park, Henry S., et al. "Impact of Hospital Volume of Thoracoscopic Lobectomy On Primary Lung Cancer Outcomes." The Annals of Thoracic Surgery, vol. 93, no. 2, 2012, pp. 372-9.
Park HS, Detterbeck FC, Boffa DJ, et al. Impact of hospital volume of thoracoscopic lobectomy on primary lung cancer outcomes. Ann Thorac Surg. 2012;93(2):372-9.
Park, H. S., Detterbeck, F. C., Boffa, D. J., & Kim, A. W. (2012). Impact of hospital volume of thoracoscopic lobectomy on primary lung cancer outcomes. The Annals of Thoracic Surgery, 93(2), 372-9. https://doi.org/10.1016/j.athoracsur.2011.06.054
Park HS, et al. Impact of Hospital Volume of Thoracoscopic Lobectomy On Primary Lung Cancer Outcomes. Ann Thorac Surg. 2012;93(2):372-9. PubMed PMID: 21945225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of hospital volume of thoracoscopic lobectomy on primary lung cancer outcomes. AU - Park,Henry S, AU - Detterbeck,Frank C, AU - Boffa,Daniel J, AU - Kim,Anthony W, Y1 - 2011/09/25/ PY - 2011/04/10/received PY - 2011/06/10/revised PY - 2011/06/14/accepted PY - 2011/9/28/entrez PY - 2011/9/29/pubmed PY - 2012/3/21/medline SP - 372 EP - 9 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 93 IS - 2 N2 - BACKGROUND: This study evaluated hospital operative volume of video-assisted thoracoscopic surgery (VATS) lobectomy in primary lung cancer as a predictor of short-term outcomes after pulmonary lobectomy on a national scale. Some previous analyses comparing VATS vs open lobectomy outcomes have been limited by inaccuracies in patient cohort identification. METHODS: The 2008 Healthcare Utilization Project-Nationwide Inpatient Sample database was culled using the International Classification of Diseases (9th Clinical Modification) procedure codes specifically distinguishing VATS vs open lobectomies (32.41 and 32.49, respectively) available only after October 2007. High hospital VATS volume was defined as 95th percentile or higher (>20 VATS/year). Univariable and multivariable analyses were used to identify independent predictors of the following outcome measures: 30-day in-hospital morbidity and mortality, hospital length of stay (LOS), and hospital costs. RESULTS: We identified 6,292 primary lung cancer patients undergoing pulmonary lobectomy, including 1,523 undergoing VATS (24%). Compared with open, VATS patients had fewer complications (38% vs 44%, p<0.001) and median LOS (5 vs 7 days; p<0.001). In multivariable analysis, VATS was an independent predictor of fewer total complications (odds ratio, 0.83; p=0.004) and shorter LOS (2.3±0.3-day difference, p<0.001). Patients undergoing VATS at high-volume VATS hospitals had shorter median LOS (4 vs 6 days, p=0.001) compared with low-volume VATS hospitals. Multivariable analysis showed high hospital VATS volume independently predicted shorter LOS (0.9±0.4-day difference, p=0.001). CONCLUSIONS: In a national database, VATS lobectomy was associated with fewer complications and shorter LOS than open lobectomy in primary lung cancer patients. Among patients undergoing VATS, high hospital volume was also associated with shorter LOS. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/21945225/Impact_of_hospital_volume_of_thoracoscopic_lobectomy_on_primary_lung_cancer_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(11)01565-7 DB - PRIME DP - Unbound Medicine ER -