The effect of surgeon volume on procedure selection in non-small cell lung cancer surgeries

Procedure selection by the surgeon can greatly affect patients' operative and long-term survival. This selection potentially reflects comfort with technically challenging surgeries. This study aims to examine surgeon choices for non-small cell lung cancer and whether surgeon volume predicts the type of procedure chosen, controlling for patient demographics, comorbidity, year of surgery, and institutional factors.

Data were abstracted from an Ontario population-based linked database from 2004 to 2011. Patient demographics, comorbidities, year of surgery, and institutional and surgical factors were evaluated. Three-level, random-effect, multilevel regression analyses were performed to examine factors influencing operative selection.

Over the interval, 8070 patients (50.4% were male) underwent surgical resection, including pneumonectomy (n = 842), lobectomy (n = 6212), and wedge resection (n = 1002). Resections were performed by 124 unique physicians in 45 institutions. The proportion of patients undergoing pneumonectomy decreased from 14.8% in 2004 to 7.6% in 2011. Multilevel regression analysis showed physician volume, age, year of procedure, gender, and comorbidities were predictive of performing a pneumonectomy. By adjusting for these variables, the results indicated that for each 10-unit increase in physician volume, the relative risk of performing a pneumonectomy decreased by 9.1% (95% confidence interval, 8.2-10.0, P = .04).

Although patient and temporal factors influence the type of resection a patient receives for non-small cell lung cancer, surgeon volume also is a strong predictor. This study may be limited by minimal stage data, but the suggestion that a surgeon's total procedural volume for non-small cell lung cancer significantly influences procedure selection has implications on how we deliver care to this patient population.