Hospital lung surgery volume and patient outcomes

Area of Science:

• Oncology
• Surgical Outcomes
• Health Services Research

Background:

• Evidence suggests a link between hospital surgical volumes and patient outcomes.
• Australian data on hospital cancer surgery volumes and patient outcomes are lacking.
• Non-small cell lung cancer (NSCLC) surgery volume and patient outcomes in Victoria require evaluation.

Purpose of the Study:

• To evaluate the relationship between hospital non-small cell lung cancer (NSCLC) surgery volume and patient outcomes in Victoria.
• To determine if higher surgical volumes correlate with improved patient outcomes for NSCLC in Australia.

Main Methods:

• Utilized the Victorian Cancer Registry (2008-2014) to identify 15,369 NSCLC patients, with 3,420 undergoing surgery.
• Defined primary outcome as 90-day mortality; secondary outcomes included overall survival, ICU admission, and ventilation.
• Categorized hospitals into quartiles based on average annual lung surgery volume (Q1: 1-17, Q4: 59+).

Main Results:

• Overall 90-day mortality was 3.5%. No significant differences in 90-day mortality or overall survival were found between low- and high-volume centers.
• Patients in lower-volume centers experienced more ICU admissions of ≥24 hours (55% vs. 11%).
• A higher proportion of patients in private hospitals (19%) had an ASA score of 4 compared to public hospitals (9%).

Conclusions:

• No survival disparities were observed between lung cancer patients treated at low- and high-volume hospitals.
• Higher rates of prolonged ICU admission were noted in lower-volume centers.
• Private hospitals reported a greater prevalence of patients with higher comorbidity scores (ASA 4).