Are minimum volume standards appropriate for lung and esophageal surgery?

Area of Science:

• Health Services Research
• Surgical Outcomes
• Healthcare Policy

Background:

• Minimum volume standards are proposed for surgical procedures like lung and esophageal resections.
• The association between proposed hospital volume cutoffs and patient outcomes remains unclear.

Purpose of the Study:

• To evaluate if proposed minimum hospital volume standards for lung and esophageal resections correlate with patient outcomes.
• To analyze differences in complications and mortality rates between low- and high-volume hospitals.

Main Methods:

• Analysis of State Inpatient Databases (2009-2011) for patients aged ≥18 undergoing lobectomy/pneumonectomy or esophagectomy for cancer.
• Hospitals categorized as low-volume (<40 lung resections/year, <20 esophagectomies/year) or high-volume.
• Propensity matching used to compare outcomes (mortality, complications, length of stay) between low- and high-volume hospital cohorts.

Main Results:

• Majority of lung (61.7%) and esophageal (82.1%) resections occurred at hospitals below proposed volume thresholds.
• No significant differences in in-hospital mortality or major complications were observed between low- and high-volume hospitals after propensity matching.
• Lung resections at low-volume hospitals had a longer median length of stay (6 vs. 5 days, P < .001), but this was not seen for esophageal resections.

Conclusions:

• Current proposed minimum volume standards for lung and esophageal resections are not associated with differences in mortality or major complications.
• Most patients undergo these procedures at hospitals not meeting proposed volume cutoffs.
• Further research is needed to establish more meaningful minimum volume requirements for surgical procedures.