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Patterns of elective lobectomy for lung cancer
Bian Liu1, Raja M Flores2, Emanuela Taioli3
1Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York.
The Journal of Surgical Research
|November 29, 2017
Summary
Access to lung cancer lobectomy varies significantly by hospital type and patient demographics. High-volume hospitals and video-assisted thoracoscopic surgery (VATS) are associated with better outcomes, highlighting the need for equitable healthcare access.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Health Services Research
Background:
- Lobectomy is the standard treatment for early-stage lung cancer.
- Limited understanding exists regarding variations in healthcare access for lobectomy, including by surgical approach like video-assisted thoracoscopic surgery (VATS).
Purpose of the Study:
- To investigate variations in hospital access and types for lung cancer lobectomy.
- To analyze these variations in relation to specific surgical techniques, such as VATS.
Main Methods:
- Analysis of the New York Statewide Planning and Research Cooperative System (2007-2012) data for elective lobectomies.
- Hospitals categorized as nearest high-volume (nHVH), distant high-volume (dHVH), close low-volume (cLVH), or distant low-volume (dLVH) based on volume and travel distance.
- Patient characteristics and postoperative outcomes were compared across hospital types.
Main Results:
- Lobectomy utilization within patient service areas varied from 44% to 82%.
- 26% of lobectomies occurred at nHVH, 34% at dHVH, 31% at cLVH, and 9% at dLVH.
- Patients at dHVH had higher VATS use and surgeon volume; adverse events were lower with VATS and high-volume surgeons but higher in cLVH/dLVH.
Conclusions:
- Multiple factors influence elective lobectomy patterns for lung cancer patients.
- Variations in access and outcomes based on hospital type and surgical approach necessitate consideration in healthcare planning.
- Ensuring equitable access to high-volume centers and VATS may improve patient outcomes.
