Original ResearchHigh lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England
Introduction
Lung cancer is one of the most frequent types of cancer and the leading cause of cancer death globally [1], [2]. There has been notable progress in lung cancer prevention, as evidenced by declining incidence rates in males [3], and treatment for lung cancer has become more active and more effective [4], [5], [6]. Surgical resection remains the preferred treatment option for medically fit patients with early-stage disease [7], [8], [9], [10].
Lung cancer surgery is highly specialised and increasingly centralised [5]. There is evidence that patient survival is better when surgical care is provided by a multidisciplinary team in hospitals with high-volume practices, and analysis of surgical data from England in patients diagnosed in 2004–2008 showed lower death rates in patients operated in large-volume hospitals [11]. It remains to be addressed whether treating patients in high-volume surgical centres can lead to improvement in other relevant outcomes, such as shorter length of hospital stay, decreased frequency and severity of post-operative complications, decreased re-admission to hospital, and improved patient experience and satisfaction. The present study extends earlier work on patients undergoing lung cancer surgery in England to examine other outcomes, specifically length of stay in hospital after lung cancer resection, and risks of re-admission and death within 30 and 90 d of surgery.
Section snippets
Study population and main predictor variables
The principles of data extraction and linkages were as described previously [9], [11]. The dataset for the analysis comprised information on 15,738 non-small-cell lung cancer patients who were resident and diagnosed in England in 2006–2010 and treated by potentially curative surgical resection as part of their initial care. The majority of resections were lobectomy (85%), 10% were pneumonectomy and 5% were other procedures. This is a complete and population-based ascertainment of surgically
Patients
Table 1 gives an overview of the study cohort of 15,738 lung cancer patients diagnosed in the period 2006–2010 in England and treated with surgical resection.
Hospital volume in relation to covariates
Table 1 shows the marginal distributions of the variables in the analysis and cross-tabulations between the quintile of lung cancer surgical procedure volume (the principal independent variable) and covariates. A high annual hospital volume was strongly associated with a high geographical resection rate (χ2 = 538.2, p < 0.0001). There was
Interpretation of the results of adjusted analyses and two-level analyses
The principal findings of these analyses are as follows:
- 1
Hospitals with large lung cancer surgical resection volumes are less conservative in their selection of patients for surgical management, and they provide a higher resection rate to their geographical population.
- 2
With adjustment for case mix, high-volume hospitals have shorter length of stay, with approximately 0.3 d difference between the extreme quintiles of hospital volume. The error of this estimate is large, however, particularly when
Conflict of interest statement
None.
Acknowledgement
The study was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' National Health Service (NHS) Foundation Trust and King's College London and by the UK National Cancer Analysis and Registration Service, Public Health England. The views expressed are those of the authors and not necessarily those of NHS, NIHR, Public Health England, or the Department of Health. The study was covered by Section 251 of the National Health Service Act
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2022, Lung CancerCitation Excerpt :The correlation between the hospital case-volume and postoperative outcome after lung cancer surgery remained inconclusive despite numerous studies [6,7,9]. A recent report analyzed 15,738 non-small cell lung cancer patients who underwent lung cancer surgery in England and showed that higher hospital surgical-volume was associated with reduced length of hospital stay, lower risk of re-admission, and lower 30- and 90-day mortality [6]. Similarly, a previous study that analyzed 2,118 non-small cell lung cancer patients who underwent lung cancer surgery between 1985 and 1996 showed that 30-day, 2-year, and 5-year overall survival were significantly better in higher-volume centers along with the lower rates of postoperative complications [7].
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2021, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :All but one of these studies reported a shorter hospital stay, but this reduction was only significant for patients operated by thoracotomy in the studies by Martin et al. [204] and Van Haren et al. [205] For example, in a study based on 234 patients, Madani et al. reported that implementation of a multimodal ERAS protocol, including early wheelchair mobilisation starting on the day of surgery and intensive pulmonary rehabilitation (hourly spirometry and respiratory physiotherapy every 4? hours), was associated with a shorter length of stay (6 [5-7] vs. 7 [6-10] days - p < 0.01) and a lower postoperative complication rate (37 vs. 50% - p? =?