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Volume-Outcome Relationships in Thoracic Surgery.

Benjamin D Kozower1, George J Stukenborg2

  • 1Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8234, St Louis, MO 63110, USA.

Thoracic Surgery Clinics
|June 26, 2017
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Summary

Hospital procedure volume and surgeon experience in thoracic surgery show a weak link to patient survival. Current quality metrics based on procedure volume for lung and esophageal cancer resections may not accurately reflect patient outcomes.

Keywords:
Cancer resectionEsophageal cancerLung cancerThoracic surgeryVolume outcome

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Area of Science:

  • Thoracic Surgery
  • Health Services Research
  • Surgical Outcomes

Background:

  • Studies suggest a link between higher hospital/surgeon procedure volume and lower mortality in thoracic surgery.
  • Controversy exists regarding the strength and validity of this volume-outcome association.
  • Procedure volume thresholds are used to guide the regionalization of care.

Purpose of the Study:

  • To examine the methodology of the volume-outcome relationship literature in thoracic surgery.
  • To highlight methodological concerns in existing studies.
  • To evaluate the use of procedure volume as a proxy for quality in lung and esophageal cancer resections.

Main Methods:

  • Literature review and critical analysis of studies investigating the volume-outcome relationship in thoracic surgery.
  • Examination of methodological approaches and potential biases in existing research.
  • Focus on lung and esophageal cancer resection data.

Main Results:

  • Methodological examination reveals significant concerns in the volume-outcome literature.
  • Lung and esophageal cancer resection volume is not strongly associated with mortality.
  • Existing evidence does not support using procedure volume as a reliable proxy for quality.

Conclusions:

  • The volume-outcome relationship in thoracic surgery, particularly for lung and esophageal cancer resections, is not as robust as commonly assumed.
  • Methodological limitations in current research question the validity of volume-based quality assessments.
  • Procedure volume should not be used as a sole or primary indicator of quality for these specific cancer surgeries.